The Approaches to Schizophrenia Communication (ASC) Tool: Including the Patient Perspective in Treatment

Adverse effects of antipsychotics are important determinants of patient attitudes towards medications, adherence to treatment, and quality of life. A discussion of adverse effects is therefore a crucial element of treatment and offers a unique opportunity for dialogue between the patient and the clinician. Unfortunately, clinicians in routine clinical practice have had very limited guidance regarding how best to initiate this discussion. In fact, despite the recognition of the importance of adverse effects, their systematic assessment has been, for the most part, confined to research settings, where the main focus has been on extrapyramidal symptoms (EPS). Furthermore, until recently, clinicians tended to discount patient subjective experiences with antipsychotic medications, focusing on the evaluation of objective severity. However, ignoring the subjective experience of patients results in inadequate communication between the patient and the clinician. The Approaches to Schizophrenia (Communication ASC) Steering Group, comprised of psychiatrists from the US, Canada and the UK, identified the need to develop a tool that could be used in routine clinical care settings to facilitate the communication between patients and clinicians regarding adverse effects. In order to be useful the instrument needed to be brief, clinically focused and easy to administer. As for the content, it needed to include the patients' subjective experiences with antipsychotics and to assess a broad adverse effect profile (i.e. both EPS and non-EPS effects). To address these needs, the Steering Group designed two checklists: the ASC-Self-Report (ASC-SR) and the ASC-Clinic (ASC-C). The ASC-SR is a self-report checklist completed by the patient. It contains a list of common problems experienced by patients receiving antipsychotics. The ASC-C is a clinician-administered version that is designed to be completed by the clinician and the patient together during a regular clinic visit. The experience with the ASC-SR and ASC-C checklists across sites and countries has been encouraging. The vast majority of respondents in a pilot study of the ASC checklists found the ASC-SR user friendly and helpful in their communication with the healthcare team. Likewise, almost half of the healthcare professionals reported that the ASC-C assisted them in identifying previously unrecognized adverse effects. Additional experience in the UK and the US has provided further support for clinical use of the checklists.