How do psychiatrists apply the minimum clinically important difference to assess patient responses to treatment?

Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID) beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and post-treatment change scores on the widely used Positive and Negative Syndrome Scale (PANSS). Psychiatrists were provided with the scale?s MCID on which to base their judgements. Our secondary objective was to assess whether knowledge of the patient?s genotype influenced psychiatrists? responder judgements. Thus psychiatrists were also informed of whether patients possessed a genotype indicating hyper-responsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower post-treatment change as indicative of a response to treatment. When psychiatrists accepted a lower post-treatment change than the MCID, they were less confident in such judgements compared to when a patient?s post-treatment change exceeded the scale?s MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyper-responsiveness genotype. Clinicians should recognise that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgements with information, such as the patient?s genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed to demonstrate patient benefits.