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Therapeutic alliance impact on analgesic outcomes in a real-world clinical setting: An observational study. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2022; 72:529-545. [PMID: 36651362 DOI: 10.2478/acph-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 01/20/2023]
Abstract
A good therapeutic alliance is relevant for healthcare providers exposed to patients' suffering, especially since patients and physicians may understand the painful experience differently. Our aim was to explore the impact of therapeutic alliance on analgesic outcomes in a real-world interdisciplinary pain unit (PU). A cross-sectional observational study was conducted on outpatients (n = 69) using opioids on a long-term basis for the treatment of chronic non-cancer pain, where clinical pharmacologists and pharmacists advised patients about their opioid treatment. Responses to the patient-doctor relationship questionnaire (PDRQ), sociodemographic and clinical information (pain level, quality of life and hospital use) were collected, whereas pharmacology data (analgesic prescription, adverse events, and compliance) were obtained from electronic health records. Patients were predominantly middle-aged (75 % women, 72 % retired), experiencing moderate pain (VAS 40-70 mm) on average, and under a high morphine equianalgesic dosage (95 ± 88 mg per day, mainly tapentadol or fentanyl). Patients with better PDRQ outcomes, and therefore better therapeutic alliance, showed lower pain intensity than patients with worse PDRQ outcomes (pain intensity: high scores 60 ± 47 mm and medium scores 60 ± 45 mm vs. low scores 80 ± 75 mm, p < 0.01). Along with this, pain intensity was lower when patients affirmed that, thanks to the health-care providers, they "gained new insight", "felt better", or "felt content with their doctor's treatment". What´s more, patients who affirmed "I benefit from the treatment" experienced increased pain relief (benefit 40 ± 30 vs. non-benefit 19 ± 26 mm, p = 0.010) and improved quality of life (benefit 33 ± 25 vs. non-benefit 18 ± 16 mm, p = 0.031). However, there was a percentage of patients who did not fully understand the provided information, which is something to be taken into account to improve in clinical routine. Therapeutic alliance supported by pharmacist experts on pain management can be an effective strategy to improve analgesic outcomes. Further efforts are needed to improve communication strategies for pain management. Future directions of research should include the analysis of the role of the pharmacist in poly-professional consultations as related to the advice of patients about their medication, and the mutual trust with the patients.
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Knuuttila V, Kuusisto K, Saarnio P, Nummi T. Early working alliance in outpatient substance abuse treatment: Predicting substance use frequency and client satisfaction. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2012.00049.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Katja Kuusisto
- School of Social Sciences and Humanities
- Institute for Advanced Social Research,IASR
| | | | - Tapio Nummi
- School of Public Health, University of Tampere, Tampere, Finland
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Interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain: a systematic review. Eur J Clin Pharmacol 2020; 77:467-490. [PMID: 33123784 PMCID: PMC7935820 DOI: 10.1007/s00228-020-03026-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022]
Abstract
Purpose Sub-optimal opioid prescribing and use is viewed as a major contributor to the growing opioid crisis. This study aims to systematically review the nature, process and outcomes of interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain (CNMP) with a particular focus on minimizing misuse of opiates. Methods A systematic review of literature was undertaken. Search of literature using Medline, EMBASE and CINAHL databases from 2000 onwards was conducted. Screening and selection, data extraction and risk of bias assessments were undertaken by two independent reviewers. Narrative synthesis of the data was conducted. Results A total of 21 studies were included in the review, of which three were RCTs. Interventions included clinical (e.g. urine drug testing, opioid treatment contract, pill count), behavioural (e.g. electrical diaries about craving), cognitive behavioural treatment and/or educational interventions for patients and healthcare providers delivered as a single or as a multi-component intervention. Medication optimization outcomes included aspects of misuse, abuse, aberrant drug behaviour, adherence and non-adherence. Although all evaluations showed improvement in medication optimization outcomes, multi-component interventions were more likely to consider and to have shown improvement in clinical outcomes such as pain intensity, quality of life, psychological states and functional improvement compared to single-component interventions. Conclusions A well-structured CNMP management programme to promote medicines optimization should include multi-component interventions delivered by a multidisciplinary team of healthcare professionals and target both healthcare professionals and patients. There was heterogeneity in definitions applied and interventions evaluated. There is a need for the development of clear and consistent terminology and measurement criteria to facilitate better comparisons of research evidence. Supplementary Information The online version of this article (10.1007/s00228-020-03026-4) contains supplementary material, which is available to authorized users.
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Richardson D, Adamson S, Deering D. Therapeutic alliance predicts mood but not alcohol outcome in a comorbid treatment setting. J Subst Abuse Treat 2018; 91:28-36. [DOI: 10.1016/j.jsat.2018.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
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Madson MB, Mohn RS, Schumacher JA, Landry AS. Measuring Client Experiences of Motivational Interviewing during a Lifestyle Intervention. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2017; 48:140-151. [PMID: 25937700 DOI: 10.1177/0748175614544687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Client Evaluation of Motivational Interviewing was used to assess MI experiences in a predominantly female, African American sample from the Southeastern U.S. who received MI-based feedback during a multi-component lifestyle intervention. MI was experienced differently than a primarily White, male, Northeastern mental health sample.
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Madson MB, Villarosa MC, Schumacher JA, Mohn RS. Evaluating the Validity of the Client Evaluation of Motivational Interviewing Scale in a Brief Motivational Intervention for College Student Drinkers. J Subst Abuse Treat 2016; 65:51-7. [DOI: 10.1016/j.jsat.2016.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 01/27/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE A working alliance (WA) is considered an essential factor in therapeutic relationships, relating to the mutual and interactive aspects of the relationship. In the medical setting, a WA has been found to be related to various positive outcomes; however, it has previously been investigated solely from the patient's perspective. The aim of the current study was to measure the concept from both sides of the patient-medical staff interaction. METHOD Physicians, nurses, and advanced cancer patients completed the Working Alliance Inventory-Short Revised. RESULTS Some 32 physicians, 39 nurses, and 52 advanced cancer patients completed the study. Senior staff members rated the WA higher than trainees, both among physicians and nurses. Physicians and nurses rated the "bonds" subscale highest, while patients rated "goals" at the highest level. In addition, a significant difference was demonstrated between physicians and patients, with patients rating the WA higher. CONCLUSIONS These preliminary findings demonstrate different perspectives among advanced cancer patients and medical staff interactions. Future studies should investigate the interactive aspects of the WA concept in the medical setting. SIGNIFICANCE OF RESULTS Awareness of the working alliance in patient-staff interactions may improve the quality of treatment given to patients confronting cancer.
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Measurement equivalence of the Revised Helping Alliance Questionnaire across African American and non-Latino White substance using adult outpatients. J Subst Abuse Treat 2013; 45:173-8. [PMID: 23522849 DOI: 10.1016/j.jsat.2013.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 02/03/2013] [Accepted: 02/13/2013] [Indexed: 11/23/2022]
Abstract
Analyses of the effectiveness of substance abuse treatments across racial/ethnic groups should ensure that outcome measures have the same conceptual meaning (i.e., measurement equivalence) across groups. Because racial groups differ in perceptions and experiences of the therapeutic alliance, this study investigated measurement equivalence properties of the Revised Helping Alliance Questionnaire (HAq-II) across racial groups. The sample included 138 African American and 133 non-Latino White participants, age 18-64 years, who participated in a randomized clinical trial investigating the effectiveness of Motivational Enhancement Therapy in the National Institute on Drug Abuse Clinical Trials Network. Results demonstrated configural invariance and two forms of metric invariance (weak and strong/scalar), suggesting that conceptualizations of therapeutic alliance and overall levels of endorsement of therapeutic alliance are comparable across racial groups. The groups indicated partial, strict metric nonequivalence. No studies to date reported measurement equivalence properties of the HAq-II. Findings support valid measurement and interpretation of HAq-II outcomes.
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Measuring client perceptions of motivational interviewing: factor analysis of the Client Evaluation of Motivational Interviewing scale. J Subst Abuse Treat 2013; 44:330-5. [DOI: 10.1016/j.jsat.2012.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 07/11/2012] [Accepted: 08/08/2012] [Indexed: 11/21/2022]
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Manne SL, Kashy DA, Rubin S, Hernandez E, Bergman C. Therapist and patient perceptions of alliance and progress in psychological therapy for women diagnosed with gynecological cancers. J Consult Clin Psychol 2012; 80:800-810. [PMID: 22746145 PMCID: PMC3763826 DOI: 10.1037/a0029158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The goal was to understand both therapist and patient perspectives on alliance and session progress for women in treatment for gynecological cancer. We used a longitudinal version of the one-with-many design to partition variation in alliance and progress ratings into therapist, patient/dyad, and time-specific components. We also evaluated therapist and patient characteristics that predict alliance and session progress. METHOD Two hundred and three women and their therapists completed measures of alliance and session progress across a 6-session course of treatment. Participants also completed preintervention measures of self-esteem, depression, cancer-specific distress, emotional expressivity, and use of protective buffering. RESULTS Patients reported higher alliance and greater progress than did therapists. When therapists reported particularly strong alliance with particular patients, those patients concurred. More experienced therapists reported higher alliances and more progress but their patients did not agree. Patients who began treatment in more difficult psychosocial circumstances tended to have less positive session outcomes on average but evidenced more improvement across therapy sessions. CONCLUSIONS Patients rated their alliance and progress more positively than did their therapists, although there was substantial relative agreement between therapists and patients. Alliance and progress improved over time, particularly among patients who evidenced higher levels of distress and poorer physical functioning. More experienced therapists were more confident in their abilities but their patients did not share this perception.
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Affiliation(s)
- Sharon L Manne
- Cancer Prevention and Control Program, Cancer Institute of New Jersey
| | | | - Stephen Rubin
- Division of Gynecological Oncology, Hospital of the University of Pennsylvania
| | - Enrique Hernandez
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine
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Lorenzoni V, Curzio O, Karakachoff M, Saponaro A, Sanza M, Mariani F, Molinaro S. The effects of the macro-environment on treatment retention for problem cocaine users. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 24:52-9. [PMID: 22884542 DOI: 10.1016/j.drugpo.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 03/14/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Client dropout is commonly used as an indicator of quality and effectiveness of drug treatment. Following increasing cocaine use in recent years, research has attempted to identify predictors of retention in treatment for cocaine users but there is no consensus about how individual characteristics and system variables (referral source, treatment setting), what we term here as the "macro-environment" - effect risk of dropout. This study sought to identify macro-environmental factors and examine the way these impact upon treatment retention. METHODS A retrospective longitudinal study of an admission cohort among drug services in Vasta Romagna in Emilia Romagna Region, Italy (up to 8 years of treatment or until discharge) was conducted to determine the effect of macro-environmental variables on retention among first time admitted cocaine-dependent clients in different treatment settings. The sample consisted of 1178 clients meeting DSM-IV-R criteria for cocaine dependence. RESULTS The joint effect of individual and system factors had a significant impact on dropout rates. In particular, lower rates of dropout were observed for those treated in prison and those who had a stable home, HR: 0.09 (0.02-0.48), or lived in rehabilitation units, HR: 0.36 (0.15-0.88), and among clients referred by the local authority and those living with parents, HR: 0.60 (0.38-0.95). CONCLUSION The combined effect of individual and system factors on retention in treatment sets a critical background necessary to assess any impact of organizational dynamics and delineate the trajectory for future interventions.
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Knuuttila V, Kuusisto K, Saarnio P, Nummi T. Effect of early working alliance on retention in outpatient substance abuse treatment. COUNSELLING PSYCHOLOGY QUARTERLY 2012. [DOI: 10.1080/09515070.2012.707116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vesa Knuuttila
- a School of Social Sciences and Humanities, University of Tampere , 33014 Tampere , Finland
| | - Katja Kuusisto
- a School of Social Sciences and Humanities, University of Tampere , 33014 Tampere , Finland
- b Institute for Advanced Social Research, University of Tampere , 33014 Tampere , Finland
| | - Pekka Saarnio
- a School of Social Sciences and Humanities, University of Tampere , 33014 Tampere , Finland
| | - Tapio Nummi
- c School of Public Health, University of Tampere , 33014 Tampere , Finland
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Therapeutische Allianz und therapeutische Prozesse in einer Gruppentherapie mit substanzabhängigen Straftätern. GRUPPENPSYCHOTHERAPIE UND GRUPPENDYNAMIK 2012. [DOI: 10.13109/grup.2012.48.2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This article is focused on improving the quality of addiction treatment. Based on observations that patients are leaving treatment too early and/or are continuing to use substances during their care, the authors propose six actions that could help reorient and revitalize this kind of clinical work: (1) conceptualize and treat addictive disorders within a psychiatric/mental health framework; (2) make the creation of a strong therapeutic alliance a core part of the healing process; (3) understand patients' addictions and other problems using models based on multiple internal parts, voices, or modes; (4) make contingency management and the use of positive reinforcement systems a standard and central practice in all treatment settings; (5) envision long-term change and healing through the lens of identity theory; and (6) integrate the growing developments in recovery culture with formal treatment.
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Affiliation(s)
- Scott H. Kellogg
- Department of Psychology, New York University, New York, New York USA
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Kolodziej ME, Muchowski PM, Hamdi NR, Morrissette P, McGowan AJ, Weiss RD. Adaptation of the patient feedback survey at a community treatment setting. Am J Addict 2012; 21:63-71. [PMID: 22211348 PMCID: PMC3699190 DOI: 10.1111/j.1521-0391.2011.00197.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The Patient Feedback Survey is a performance improvement measure designed to assess the quality of outpatient substance abuse treatment. We modified and administered this measure to 500 individuals at a multisite treatment provider. Although the feedback scores were high in general, analyses of variance showed score variability in relation to type and length of treatment. Moreover, respondents who reported any use of marijuana, cravings for substances, or mutual-support group attendance (ie, Alcoholics Anonymous or Narcotics Anonymous) had lower feedback scores than respondents without these experiences. We highlight the importance of investigating treatment evaluations in the context of other recovery experiences.
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Elad-Strenger J, Littman-Ovadia H. The Contribution of the Counselor–Client Working Alliance to Career Exploration. JOURNAL OF CAREER ASSESSMENT 2011. [DOI: 10.1177/1069072711420850] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This longitudinal study examines the effects of Israeli counselors’ and clients’ ratings of their working alliance on clients’ career exploration (CE), using a sample of 94 three-session career counseling processes. Results reveal that both clients’ and counselors’ working alliance ratings increased over time; yet, clients’ ratings remained constantly above counselors’ ratings. Results also suggest that clients’ working alliance ratings are a better predictor of clients’ CE than counselors’ ratings. Implications for career counseling are discussed.
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Waghorn G, De Souza T, Rampton N, Lloyd C. The working alliance in supported employment for people with severe mental health problems. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.6.42434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Geoff Waghorn
- The Queensland Centre for Mental Health Research (QCMHR), and The School of Population Health, The University of Queensland,
| | - Tara De Souza
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland,
| | - Nicole Rampton
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland and
| | - Chris Lloyd
- School of Population Health, The University of Queensland, Australia
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