Vidyya Medical News Service
Volume 6 Issue 12 Published - 14:00 UTC 08:00 EST 12-Jan-2004 Next Update - 14:00 UTC 08:00 EST 13-Jan-2004
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Patients with schizophrenia to benefit from new communication tool (2-COM)

A new study published in the leading psychiatry journal The British Journal of Psychiatry shows that a simple communication tool called '2-COM', which facilitates patient-psychiatrist communication, enables patients to play a greater role in contributing to the overall management of their condition and can lead to changes in how patients are treated. The results also found that 2-COM was of greatest value to those patients who have the highest levels of unmet need.(1)

2-COM is a simple checklist identifying 20 common `problems' that a patient with severe mental illness might experience. The list includes problems associated with housing, relationships, money, lack of activities, psychological distress, sexuality, disease symptoms and treatment side effects. In addition, 2-COM includes a set of three analogue scales designed to allow longitudinal assessment of the patient's experience of treatment, ability to cope with social environments, and overall sense of wellbeing.

In the study, one of the few randomised controlled trials of a non-pharmacological intervention in psychiatry, 134 patients with schizophrenia or schizoaffective disorder were randomly allocated to receive standard care or standard care plus 2-COM. Before seeing their clinician for their routine appointment, the active group were given the 2-COM checklist to complete and asked to indicate the areas that they wanted to discuss with their clinician. Outcomes were assessed immediately after the appointment and at a follow up after six weeks.

The results showed that using 2-COM induced a stable improvement in patient-reported quality of patient-psychiatrist communication irrespective of illness severity and the number of needs reported. Patients receiving 2-COM also experienced a decrease in the number of reported needs between the second and third visits. 2-COM also prompted change in psychiatrists' clinical behaviour immediately following the appointment as demonstrated by a greater likelihood of treatment change, both pharmacological and non-pharmacological. The change in treatment was also found to be more likely in those patients who reported more needs.

Professor Jim van Os, from Maastricht University, The Netherlands, and lead author of the study commented, "We are delighted that the results of this trial confirm the benefits for both patients and clinicians of adopting this simple communication tool in everyday practice. The results suggest that providing patients with an opportunity to steer the focus of their appointment may actually engender and facilitate a discussion about care needs that results in actual changes in their management that might otherwise not have occurred. These management changes may in turn ultimately result in improved patient outcomes, although further long-term analysis is needed to confirm this. On the basis of this study, we would encourage psychiatrists to adopt 2-COM in their practice."

2-COM was developed by a group of leading psychiatrists from around Europe in response to research indicating improvement in patient-psychiatrist communication can lead to improved patient outcomes, and was supported by an unrestricted educational grant from AstraZeneca Neuroscience. The results of this trial support earlier research published last year in the leading psychiatry journal Acta Psychiatrica Scandinavica which showed 2-COM significantly improved patients' level of satisfaction with their treatment by facilitating greater patient-psychiatrist communication in routine clinical practice.(2)

The 2-COM checklist is available in nine different languages from the following web addresses: or The English version and instructions for its use appear in today's issue of Vidyya.


1. Van Os J, Altamura AC, Bobes J, Gerlach J, Hellewell JS, Kasper S, Naber D, Robert P. (2004) Evaluation of the 2-COM communication tool as a clinical intervention: Results of a multi-national randomized controlled trial. Br J Psychiatry. Jan;184(1):79-83.

2. Van Os et al (2002) 2-COM: an instrument to facilitate patient-professional communication in routine clinical practice. Acta Psychiatr Scand

European Psychiatrists that contributed to the development of 2-COM included: J. van Os (Maastricht University, Netherlands); A.C. Altamura (Universita degli Studi Di Milano, Italy); J. Bobes (Universidad de Oviedo, Spain); D.C. Owens (University of Edinburgh, UK); J. Gerlach (St Hans Hospital, Denmark); J. S. E. Hellewell (Trafford General Hospital, UK); S. Kasper (University Hospital for Psychiatry, Austria); D. Naber (Klinik fur Psychiatrie und Psychotherapie der Universitat Hamburg, Germany) & P. Robert (Hopital Pasteur, France)

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