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

Rosa Glaser¹Johannes Zang²Britta Kelch^1,3Silke Jörgens^1,3Inga Stonner¹Viktor T. H. Wahner¹Ewa Ferensztajn-Rochowiak⁴Dobrochna Kopeć⁴Martina Contu⁵Pasquale Paribello⁵Marco Pinna⁵Mara Dierssen⁶Massimo Gennarelli^7,8Mirko Manchia^10,5,9Alessandra Minelli^7,8Júlia Perera Bel¹¹Marie-Claude Potier¹²Filip Rybakowski¹³Ferran Sanz^11,14Alessio Squassina^15,16Bernhard T Baune^1,17,18*

• ¹Department of Psychiatry, University of Münster, Münster, Germany
• ²Department of General Internal Medicine and Psychosomatic, University Hospital Heidelberg, Heidelberg, Germany
• ³Department Hamm 2, Hochschule Hamm-Lippstadt, Hamm-, Germany
• ⁴Department of Adult Psychiatry, Poznan University of Medical Sciences,, Poznan, Poland
• ⁵Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
• ⁶Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
• ⁷Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
• ⁸Genetics Unit, San Giovanni di Dio Fatebenefratelli Center (IRCCS), Brescia, Italy
• ⁹Department of Pharmacology, Dalhousie University, Halifax, Canada
• ¹⁰Unit of Clinical Psychiatry, Department of Medicine, University Hospital Agency of Cagliari, Cagliari, Italy
• ¹¹Research Programme on Biomedical Informatics (GRIB), Hospital del Mar Research Institute (IMIM), Barcelona, Spain
• ¹²Paris Brain Institute (ICM), National Centre for Scientific Research (CNRS), Paris, France
• ¹³Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
• ¹⁴Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
• ¹⁵Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
• ¹⁶Department of Psychiatry, Dalhousie University, Halifax, Canada
• ¹⁷Florey Institute of Neuroscience and Mental Health, Parkville, Australia
• ¹⁸Department of Psychiatry, University of Melbourne, Parkville, Australia

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-centered communication strategies and guidelines for the ethical implementation of precision psychiatry.