{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T05:19:25Z","timestamp":1777785565830,"version":"3.51.4"},"reference-count":12,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T00:00:00Z","timestamp":1670803200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Am Psychiatr Nurses Assoc"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>INTRODUCTION:<\/jats:title>\n                    <jats:p>Treatment-resistant depression (TRD) exists when patient depression continues without remission or reduction despite treatment. There are no standardized guidelines for identifying TRD, but one failed antidepressant treatment at an adequate dose and duration can constitute TRD, especially in cases of severe depression or suicidality. TRD rates for depressed patients average approximately 50% to 60% of the general population. These numbers are higher in the military population and are often complicated by comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>AIM:<\/jats:title>\n                    <jats:p>Chart audits revealed 68% of psychiatric clinic outpatient veterans met criteria for TRD. Only 25% of patients were being treated adequately for TRD, and 0% were offered other options for treatment. This project aimed to improve patient-centered TRD care at a veteran\u2019s hospital to 80% within 90 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This quality improvement project was implemented using plan-do-study-act (PDSA) cycles. Interventions were tested over four rapid-cycle phases with improvements for screening, handouts, surveys, and team meetings over 8 weeks. Four core interventions were followed throughout the project: screening for TRD, right-care case management tracking, patient engagement with shared decision-making (SDM), and team engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Starting from a baseline right-care score of 25%, the project attained an overall mean of 99.6% representing improved patient-centered TRD care and surpassing the 80% goal defined in the aim.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Overall TRD care was improved using SDM options and inter-clinic teamwork and communication.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10783903221141885","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T23:54:01Z","timestamp":1670889241000},"page":"7-14","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Improving Patient-Centered Care for Veterans With Treatment-Resistant Depression Using Shared Decision-Making Tools"],"prefix":"10.1177","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7988-3122","authenticated-orcid":false,"given":"Cheyenne M.","family":"Allen","sequence":"first","affiliation":[{"name":"Cheyenne M. Allen, DNP, PMHNP-BC, Clarion University of Pennsylvania, Clarion, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Bray","sequence":"additional","affiliation":[{"name":"Carla Bray, DNP, FNP-C, Frontier Nursing University, Versailles, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,12,12]]},"reference":[{"key":"bibr1-10783903221141885","unstructured":"Agency for Healthcare Research and Quality. (2018). Six domains of health care quality. https:\/\/www.ahrq.gov\/talkingquality\/measures\/six-domains.html"},{"key":"bibr2-10783903221141885","doi-asserted-by":"crossref","unstructured":"Chen K., Kruger J., McCarther N., Meah Y. (2020). Interprofessional, learner-driven collaboration for innovative solutions to healthcare delivery in student-run clinics. Journal of Interprofessional Care, 34(1), 137\u2013139. https:\/\/doi.org.frontier.idm.oclc.org\/10.1080\/13561820.2019.1635094","DOI":"10.1080\/13561820.2019.1635094"},{"key":"bibr3-10783903221141885","unstructured":"Department of Veterans Affairs, Department of Defense. (2016). VA\/DoD Clinical practice guideline for the management of major depressive disorder."},{"key":"bibr4-10783903221141885","unstructured":"Gebara M. A., DiNapoli E. A., Hamm M. E., Rodriguez K. L., Kasckow J. W., Lederer L. G., Bramoweth A. D., Karp J. F. (2020). Illness narratives and preferences for treatment among older veterans living with treatment-resistant depression and insomnia. Annals of Clinical Psychiatry, 32(2), 81\u201389. https:\/\/frontier.idm.oclc.org\/login?url=https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=psyh&AN=2020-48575-001&site=eds-live&scope=site&profile=eds"},{"key":"bibr5-10783903221141885","doi-asserted-by":"crossref","unstructured":"Jansen M. A. (2018). Psychosocial services for individuals with serious mental illness\/severe emotional disturbance: Clinical practice guideline toolkit. Psychiatry, 81(1), 3\u201321. https:\/\/doi.org\/10.1080\/00332747.2018.1440116","DOI":"10.1080\/00332747.2018.1440116"},{"key":"bibr6-10783903221141885","doi-asserted-by":"crossref","unstructured":"Kameg B. N., Kameg K. M. (2021). Treatment-resistant depression: An overview for psychiatric advanced practice nurses. Perspectives in Psychiatric Care, 57(2), 689\u2013694. https:\/\/doi.org.frontier.idm.oclc.org\/10.1111\/ppc.12596","DOI":"10.1111\/ppc.12596"},{"key":"bibr7-10783903221141885","doi-asserted-by":"crossref","unstructured":"Loh A., Simon D., Wills C. E., Kriston L., Niebling W., H\u00e4rter M. (2007). The effects of a shared decision-making intervention in primary care of depression: A cluster-randomized controlled trial. Patient Education and Counseling, 67(3), 324\u2013332. https:\/\/doi.org.frontier.idm.oclc.org\/10.1016\/j.pec.2007.03.023","DOI":"10.1016\/j.pec.2007.03.023"},{"key":"bibr8-10783903221141885","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4088\/JCP.0707e17","volume":"68","author":"Nemeroff C. B.","year":"2007","journal-title":"The Journal of Clinical Psychiatry"},{"key":"bibr9-10783903221141885","volume-title":"Fundamentals of healthcare improvement: A guide to improving your patients\u2019 care","author":"Ogrinc G. S.","year":"2018","edition":"3"},{"key":"bibr10-10783903221141885","doi-asserted-by":"crossref","unstructured":"Rodenburg V. S., Carlier I., Vliet I., Hemert A., Stiggelbout A., Zitman F. (2020). Patients\u2019 and clinicians\u2019 perspectives on shared decision-making regarding treatment decisions for depression, anxiety disorders, and obsessive-compulsive disorder in specialized psychiatric care. Journal of Evaluation in Clinical Practice, 26(2), 645\u2013658. https:\/\/doi.org.frontier.idm.oclc.org\/10.1111\/jep.13285","DOI":"10.1111\/jep.13285"},{"key":"bibr11-10783903221141885","doi-asserted-by":"crossref","unstructured":"Rybak Y. E., Lai K. S. P., Ramasubbu R., Vila R. F., Blumberger D. M., Chan P., Delva N., Giacobbe P., Gosselin C., Kennedy S. H., Iskandar H., McInerney S., Ravitz P., Sharma V., Zaretsky A., Burhan A. M. (2021). Treatment-resistant major depressive disorder: Canadian expert consensus on definition and assessment. Depression and Anxiety, 38(4), 456\u2013467. https:\/\/doi.org.frontier.idm.oclc.org\/10.1002\/da.23135","DOI":"10.1002\/da.23135"},{"key":"bibr12-10783903221141885","doi-asserted-by":"crossref","unstructured":"Zisook S., Tal I., Weingart K., Hicks P., Davis L. L., Chen P., Yoon J., Johnson G. R., Vertrees J. E., Rao S., Pilkinton P. D., Wilcox J. A., Sapra M., Iranmanesh A., Huang G. D., Mohamed S. (2016). Characteristics of U.S. veteran patients with major depressive disorder who require \u201cnext-step\u201d treatments: A VAST-D report. 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