Factors influencing patient decision-making on a multimodal precision medicine algorithm for depression: a qualitative European multicentre study of the PROMPT consortium

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Background: Precision medicine promises to improve treatment outcomes by tailoring interventions to patients' individual characteristics. However, the use of precision medicine tools requires patient acceptance, which remains underexplored. This qualitative study investigated factors influencing patient perspectives on a multimodal precision medicine algorithm to predict antidepressant response in patients suffering from Major Depressive Disorder (MDD). Methods: To explore patients' perspectives on the use of a multimodal algorithm, semi-structured focus groups were conducted with 44 patients diagnosed with moderate to severe depression across three European sites (Germany, Poland, Italy) in the PROMPT study. Discussions were transcribed and translated into English for analysis. A qualitative, structured content analysis approach was then used to analyse the data. Results: Patients' perspectives on using a multimodal algorithm in MDD revealed a complex interplay of decision-making factors: while perceived clinical benefits, such as a reduction in trial-and-error prescribing and reassurance, promoted acceptance of the algorithm, concerns about cost, waiting time and the emotional impact of unfavourable results tended to discourage acceptance. Patients' general beliefs about mental illness and its treatment shaped their attitudes toward the application of the algorithm. Many participants emphasised the importance of trust in physicians and preferred testing within the context of an established therapeutic relationship. Misconceptions about the algorithm's accuracy and capabilities, and fears of medical reductionism, were common. Conclusions: While patients are open to the use of a multimodal precision medicine algorithm for MDD, they emphasised the need for individualised, transparent communication and emotional support. The results highlight the importance of patient-centred communication strategies and guidelines for the ethical implementation of precision psychiatry.

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