Letting patients lead? Practitioners' experiences of using DIALOG+ in psychosis outpatient care - patient involvement, collaborative dynamics, and professional roles.

BACKGROUND: Severe mental illness, such as psychosis, significantly affects many areas of life. Involving patients in their care may enhance engagement and support recovery by ensuring that treatment focuses on their expressed needs. DIALOG+ is an intervention, supported by a digital tool, aimed at facilitating patient involvement in treatment by incorporating self-assessment and a problem-solving approach during routine clinical encounters and promoting a collaborative and patient-centred approach to care. The aim of this study was to explore mental health practitioners' (MHPs) experiences of how DIALOG+ influenced patient involvement and the dynamics of collaboration in outpatient psychosis care.

METHODS: A qualitative study was designed to describe MHPs' experiences of using DIALOG+ in psychosis outpatient care in Sweden. Fourteen MHPs who had used DIALOG+ three times or more were included in the study. Four focus groups were conducted using semi-structured interviews and analysed through reflexive thematic analysis.

RESULTS: The analysis of MHPs' experiences resulted in three themes: "The patient's voice and engagement," "The relationship between patient and mental health practitioner," and "Professional challenges and changes in the practitioner's role." DIALOG+'s structured approach made it easier for patients to express their needs and take a more active role in the conversation, sometimes leading to increased patient engagement. The intervention also seemed to balance the conversation by sharing responsibility for decisions and follow-up between patients and practitioners. At the same time, practitioners reflected on challenges when letting the patient lead the conversation, which could result in time constraints and the need to balance patient-led agendas with professional responsibility.

CONCLUSION: DIALOG+ has the potential to support the operationalisation of co-production in outpatient psychosis care by increasing patients' influence over the agenda in routine clinical encounters. It provides a structured framework for shared reflection and action planning, while also making visible potential differences between patients' preferences and practitioners' clinical assessments that can be negotiated. However, its impact depends on how the approach is enacted in practice. Supporting practitioners in navigating shifts in professional roles and authority may therefore be important for realising the full potential of the intervention.