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Ribic E, Sikira H, Dzubur Kulenovic A, Pemovska T, Russo M, Jovanovic N, Radojicic T, Repisti S, Milutinović M, Blazevska B, Konjufca J, Ramadani F, Jerotic S, Savic B. Perceived sustainability of psychosocial treatment in low- and middle-income countries in South-Eastern Europe. BJPsych Open 2022; 8:e156. [PMID: 35968901 PMCID: PMC9438482 DOI: 10.1192/bjo.2022.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND DIALOG+ is an evidence-based, generic, cost-saving and easily deliverable psychosocial intervention, adaptable to clinicians' personal manner of interaction with patients. It was implemented in mental health services in five low- and middle-income countries in South-Eastern Europe during a 12-month randomised-controlled trial (IMPULSE) to improve the effectiveness of out-patient treatment for people with psychotic disorders. AIMS To investigate barriers and facilitators to the perceived sustainability of DIALOG+ that has been successfully implemented as a part of the IMPULSE project. METHOD Three months after the IMPULSE trial's end, perceived sustainability of the DIALOG+ intervention was assessed via a short survey of clinicians and patients who took part in the trial. Quantitative data collected from the survey were analysed using descriptive statistics; content analysis assessed qualitative survey data. The views and experiences of key informants (patients, clinicians and healthcare policy influencers) regarding the sustainability and scale-up of DIALOG+ were further explored through semi-structured interviews. These data were explored using framework analysis. RESULTS Clinicians mostly appreciated the comprehensiveness of DIALOG+, and patients described DIALOG+ meetings as empowering and motivating. The barrier most commonly identified by key informants was availability of financial resources; the most important facilitators were the clinically relevant structure and comprehensiveness of the DIALOG+ intervention. CONCLUSIONS Participants showed a willingness to sustain the implementation of DIALOG+. It is important to maintain collaboration with healthcare policy influencers to improve implementation of DIALOG+ across different levels of healthcare systems and ensure availability of resources for implementing psychosocial interventions such as DIALOG+.
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Affiliation(s)
- Emina Ribic
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Hana Sikira
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Tamara Pemovska
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK; and WHO Collaborating Centre for Mental Health Services Development, Bart's and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Manuela Russo
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Nikolina Jovanovic
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK; and Newham Centre for Mental Health, London, UK
| | | | | | | | | | - Jon Konjufca
- Department of Psychology, University of Prishtina 'Hasan Prishtina', Prishtina, Kosovo, Albania; and University of Prishtina, Kosovska Mitrovica, Serbia
| | - Fjolla Ramadani
- Department of Psychology, University of Prishtina 'Hasan Prishtina', Prishtina, Kosovo, Albania
| | - Stefan Jerotic
- Department of Psychiatry, University Clinical Center of Serbia, Belgrade, Serbia; and Department of Psychiatry, Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bojana Savic
- University Clinical Center of Serbia, Belgrade, Serbia
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Clark C, Holttum S. 'A life I can cope with'. An alternative model of cognitive behavioural therapy (CBT) for CFS/ME. Health Expect 2021; 25:91-102. [PMID: 34472690 PMCID: PMC8849251 DOI: 10.1111/hex.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/14/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to explore the experience of cognitive behavioural therapy (CBT) aimed at better management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), rather than increasing activity. Design This was a qualitative study using grounded theory analysis. Methods Semi‐structured interviews were conducted with 13 adults who had engaged in CBT at a specialist CFS/ME service in which CBT is aimed at improved management of the condition. Results A model was produced in which participants felt more able to cope with CFS/ME. Reduced fatigue did not seem to be a necessary precondition to managing. This has implications for CBT for CFS/ME. Conclusions Specialist CBT for CFS/ME may result in improved coping and reduced distress, independently of changes in fatigue. Patient or Public Contribution The researcher met with a representative from the university's service user advisory group (SAGE), who had lived experience of CFS/ME. They commented on possible questions for the interview topic guide and provided advice on ways in which ethical issues specific to CFS/ME could be considered, for example, prevention of harm during interviews. Second, for quality assurance as part of respondent validation, a proposed draft of the grounded theory was discussed with participants.
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Affiliation(s)
- Catherine Clark
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
| | - Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
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Scope A, Leaviss J, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R. The acceptability of primary care or community-based behavioural interventions for persistent physical symptoms: Qualitative systematic review. Br J Health Psychol 2021; 26:1069-1094. [PMID: 33797174 DOI: 10.1111/bjhp.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Persistent physical symptoms (PPS) are often associated with profound physical disability and psychological distress. Interventions for PPS that promote behavioural change aim to reduce levels of symptoms and improve overall functioning in patients. The evidence for these interventions is mixed, with effective relationships between patients and health practitioners (HPs) reported as the key to the success of primary care interventions. The objectives of this systematic review were to synthesize the qualitative evidence and to evaluate the acceptability of behavioural interventions for PPS in primary care, from the perspective of both patients and HPs. METHODS A comprehensive literature search was conducted in seven major electronic bibliographic databases, to February 2019. The aim was to identify a broad range of literature including, qualitative research, mixed methods research, and qualitative data embedded in trial reports or process evaluations. Fifty-eight full papers were screened against the inclusion criteria. Nine studies were included and quality-assessed. A qualitative evidence synthesis was conducted using thematic synthesis. RESULTS Some patients and HPs reported positive gains from taking part in or delivering interventions, with appropriate support and explanation of their symptoms important for patients. Barriers appeared to be underpinned by the relationship between the patients and HPs, and by beliefs and attitudes held by both parties. CONCLUSIONS Patients should be provided with adequate information to make an informed decision about whether an intervention is appropriate for them, and interventions should not end suddenly or without adequate follow-up. HPs should receive training and supervision to address their lack of confidence, and improve their knowledge of PPS.
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Affiliation(s)
- Alison Scope
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
| | - Joanna Leaviss
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
| | - Marta Buszewicz
- Research Department of Primary Care and Population Health, University College London, UK
| | - Rona Moss-Morris
- Psychological Medicine and Integrated Care Clinical Academic Group, Department of Psychology, Kings College London, UK
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Hanssen DJC, Ras A, Rosmalen JGM. Barriers and facilitators to the implementation of interventions for medically unexplained symptoms in primary care: A modified Delphi study. J Psychosom Res 2021; 143:110386. [PMID: 33588284 DOI: 10.1016/j.jpsychores.2021.110386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/18/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Medically Unexplained Symptoms (MUS) are physical symptoms that last for longer than several weeks and for which no (sufficient) somatic explanation can be found. Interventions for treating MUS in primary care are available, but their implementation in daily practice appears difficult. In the current study we aim to explore key barriers and facilitators to the implementation of MUS-interventions in primary care. METHODS A three-round modified Delphi study was performed, using the input of 58 experts that are (in)directly involved in the care for patients with MUS (e.g. general practitioners (GPs), GP mental health workers, policy advisors). In the first online questionnaire, we generated ideas about relevant barriers and facilitators on different implementation levels. These ideas were independently coded by two researchers, and reformulated into unique barriers and facilitators. In round two, participants selected the ten most relevant barriers and facilitators from round one, which were ranked on importance in round three. RESULTS We identified 42 unique barriers and 57 unique facilitators to the implementation of MUS-interventions. The three highest ranked barriers were all related to time, i.e. too little time for treating complex MUS-patients. The most important facilitator was a positive attitude towards MUS-patients. Results varied somewhat per profession. CONCLUSION Key barriers and facilitators to the implementation of MUS-interventions seem to exist on the level of the patient, intervention, professional, organization, and external context. All of these levels should be taken into account in order to increase implementation success of MUS-interventions in primary care.
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Affiliation(s)
- Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, The Netherlands.
| | - Anika Ras
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, The Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion Regulation, Groningen, The Netherlands
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A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE). ACTA ACUST UNITED AC 2020; 57:medicina57010007. [PMID: 33374291 PMCID: PMC7823627 DOI: 10.3390/medicina57010007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023]
Abstract
Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.
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Mengshoel AM, Helland IB, Meeus M, Castro-Marrero J, Pheby D, Bolle Strand E. Patients' experiences and effects of non-pharmacological treatment for myalgic encephalomyelitis/chronic fatigue syndrome - a scoping mixed methods review. Int J Qual Stud Health Well-being 2020; 15:1764830. [PMID: 32432991 PMCID: PMC7782327 DOI: 10.1080/17482631.2020.1764830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The EU COST Action 15111 collaboration on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) aims to assess current research and identify knowledge gaps in Europe. Presently, our purpose is to map the effects of non-pharmacological therapies (NPTs) for ME/CFS, and what patients find important in the treatment process. METHODS A scoping mixed methods literature review of European studies identified 16 papers fulfiling our inclusion criteria. The quantitative and qualitative studies were synthesized separately in tables. Additionally, extracts from the qualitative studies were subjected to translational analysis. RESULTS Effect studies addressed cognitive behavioural therapy (CBT, n = 4), multimodal rehabilitation (n = 2) and activity-pacing (n = 2). CBT reduced fatigue scores more than usual care or waiting list controls. The effects of rehabilitation and activity-pacing were inconsistent. The contents, assessment methods and effects of rehabilitation and activity pacing studies varied. For patients, health professionals' recognition of ME/CFS and support were crucial, but they expressed ambiguous experiences of what the NPTs entail. CONCLUSIONS Methodological differences make comparisons across NPTs impossible, and from a patient perspective the relevance of the specific contents of NPTs are unclear. Future well-designed studies should focus on developing NPTs tailored to patients' concerns and evaluation tools reflecting what is essential for patients.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Bergliot Helland
- Norwegian National Advisory Unit on CFS/ME, Division of Pediatrics and Adolescents, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
- Pain in Motion, International Research Group
| | - Jesus Castro-Marrero
- CFS/ME Unit, Vall d’Hebron University Hospital Research Institute, Universitat Autònoma De Barcelona, Barcelona, Spain
| | - Derek Pheby
- Society and Health, Buckinghamshire New University, High Wycombe, UK
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Pilkington K, Ridge DT, Igwesi-Chidobe CN, Chew-Graham CA, Little P, Babatunde O, Corp N, McDermott C, Cheshire A. A relational analysis of an invisible illness: A meta-ethnography of people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and their support needs. Soc Sci Med 2020; 265:113369. [DOI: 10.1016/j.socscimed.2020.113369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/17/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
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Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P. Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. Health Technol Assess 2020; 24:1-490. [PMID: 32975190 PMCID: PMC7548871 DOI: 10.3310/hta24460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The term 'medically unexplained symptoms' is used to cover a wide range of persistent bodily complaints for which adequate examination and appropriate investigations do not reveal sufficiently explanatory structural or other specified pathologies. A wide range of interventions may be delivered to patients presenting with medically unexplained symptoms in primary care. Many of these therapies aim to change the behaviours of the individual who may have worsening symptoms. OBJECTIVES An evidence synthesis to determine the clinical effectiveness and cost-effectiveness of behavioural modification interventions for medically unexplained symptoms delivered in primary care settings was undertaken. Barriers to and facilitators of the effectiveness and acceptability of these interventions from the perspective of patients and service providers were evaluated through qualitative review and realist synthesis. DATA SOURCES Full search strategies were developed to identify relevant literature. Eleven electronic sources were searched. Eligibility criteria - for the review of clinical effectiveness, randomised controlled trials were sought. For the qualitative review, UK studies of any design were included. For the cost-effectiveness review, papers were restricted to UK studies reporting outcomes as quality-adjusted life-year gains. Clinical searches were conducted in November 2015 and December 2015, qualitative searches were conducted in July 2016 and economic searches were conducted in August 2016. The databases searched included MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and EMBASE. Updated searches were conducted in February 2019 and March 2019. PARTICIPANTS Adult participants meeting the criteria for medically unexplained symptoms, including somatoform disorders, chronic unexplained pain and functional somatic syndromes. INTERVENTIONS Behavioural interventions were categorised into types. These included psychotherapies, exercise-based interventions, multimodal therapies (consisting of more than one intervention type), relaxation/stretching/social support/emotional support, guided self-help and general practitioner interventions, such as reattribution. Evidence synthesis: a network meta-analysis was conducted to allow a simultaneous comparison of all evaluated interventions in a single coherent analysis. Separate network meta-analyses were performed at three time points: end of treatment, short-term follow-up (< 6 months since the end of treatment) and long-term follow-up (≥ 6 months after the end of treatment). Outcomes included physical and psychological symptoms, physical functioning and impact of the illness on daily activities. Economic evaluation: within-trial estimates of cost-effectiveness were generated for the subset of studies where utility values (or quality-adjusted life-years) were reported or where these could be estimated by mapping from Short Form questionnaire-36 items or Short Form questionnaire-12 items outcomes. RESULTS Fifty-nine studies involving 9077 patients were included in the clinical effectiveness review. There was a large degree of heterogeneity both between and within intervention types, and the networks were sparse across all outcomes. At the end of treatment, behavioural interventions showed some beneficial effects when compared with usual care, in particular for improvement of specific physical symptoms [(1) pain: high-intensity cognitive-behavioural therapy (CBTHI) standardised mean difference (SMD) 0.54 [95% credible interval (CrI) 0.28 to 0.84], multimodal SMD 0.52 (95% CrI 0.19 to 0.89); and (2) fatigue: low-intensity cognitive-behavioural therapy (CBTLI) SMD 0.72 (95% CrI 0.27 to 1.21), relaxation/stretching/social support/emotional support SMD 0.87 (95% CrI 0.20 to 1.55), graded activity SMD 0.51 (95% CrI 0.14 to 0.93), multimodal SMD 0.52 (95% CrI 0.14 to 0.92)] and psychological outcomes [(1) anxiety CBTHI SMD 0.52 (95% CrI 0.06 to 0.96); (2) depression CBTHI SMD 0.80 (95% CrI 0.26 to 1.38); and (3) emotional distress other psychotherapy SMD 0.58 (95% CrI 0.05 to 1.13), relaxation/stretching/social support/emotional support SMD 0.66 (95% CrI 0.18 to 1.28) and sport/exercise SMD 0.49 (95% CrI 0.03 to 1.01)]. At short-term follow-up, behavioural interventions showed some beneficial effects for specific physical symptoms [(1) pain: CBTHI SMD 0.73 (95% CrI 0.10 to 1.39); (2) fatigue: CBTLI SMD 0.62 (95% CrI 0.11 to 1.14), relaxation/stretching/social support/emotional support SMD 0.51 (95% CrI 0.06 to 1.00)] and psychological outcomes [(1) anxiety: CBTHI SMD 0.74 (95% CrI 0.14 to 1.34); (2) depression: CBTHI SMD 0.93 (95% CrI 0.37 to 1.52); and (3) emotional distress: relaxation/stretching/social support/emotional support SMD 0.82 (95% CrI 0.02 to 1.65), multimodal SMD 0.43 (95% CrI 0.04 to 0.91)]. For physical functioning, only multimodal therapy showed beneficial effects: end-of-treatment SMD 0.33 (95% CrI 0.09 to 0.59); and short-term follow-up SMD 0.78 (95% CrI 0.23 to 1.40). For impact on daily activities, CBTHI was the only behavioural intervention to show beneficial effects [end-of-treatment SMD 1.30 (95% CrI 0.59 to 2.00); and short-term follow-up SMD 2.25 (95% CrI 1.34 to 3.16)]. Few effects remained at long-term follow-up. General practitioner interventions showed no significant beneficial effects for any outcome. No intervention group showed conclusive beneficial effects for measures of symptom load (somatisation). A large degree of heterogeneity was found across individual studies in the assessment of cost-effectiveness. Several studies suggested that the interventions produce fewer quality-adjusted life-years than usual care. For those interventions that generated quality-adjusted life-year gains, the mid-point incremental cost-effectiveness ratios (ICERs) ranged from £1397 to £129,267, but, where the mid-point ICER fell below £30,000, the exploratory assessment of uncertainty suggested that it may be above £30,000. LIMITATIONS Sparse networks meant that it was not possible to conduct a metaregression to explain between-study differences in effects. Results were not consistent within intervention type, and there were considerable differences in characteristics between studies of the same type. There were moderate to high levels of statistical heterogeneity. Separate analyses were conducted for three time points and, therefore, analyses are not repeated-measures analyses and do not account for correlations between time points. CONCLUSIONS Behavioural interventions showed some beneficial effects for specific medically unexplained symptoms, but no one behavioural intervention was effective across all medically unexplained symptoms. There was little evidence that these interventions are effective for measures of symptom load (somatisation). General practitioner-led interventions were not shown to be effective. Considerable heterogeneity in interventions, populations and sparse networks mean that results should be interpreted with caution. The relationship between patient and service provider is perceived to play a key role in facilitating a successful intervention. Future research should focus on testing the therapeutic effects of the general practitioner-patient relationship within trials of behavioural interventions, and explaining the observed between-study differences in effects within the same intervention type (e.g. with more detailed reporting of defined mechanisms of the interventions under study). STUDY REGISTRATION This study is registered as PROSPERO CRD42015025520. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 46. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Joanna Leaviss
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shijie Ren
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jean Hamilton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alison Scope
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Glenys Parry
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Marta Buszewicz
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Peter White
- Barts and The London School of Medicine and Dentistry, London, UK
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Williams S, Turner AM, Beadle H. Experience-based co-design to improve a pulmonary rehabilitation programme. Int J Health Care Qual Assur 2019; 32:778-787. [PMID: 31195934 DOI: 10.1108/ijhcqa-04-2018-0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate patient perspectives on attending pulmonary rehabilitation (PR). This qualitative case study identifies the benefits and challenges to attending PR and presents areas of improvements as recommended by patients. DESIGN/METHODOLOGY/APPROACH A qualitative case study of a UK case study based on a PR programme based on undertaking focus groups (n=3) and interviews (n=15) with current and former patients. FINDINGS The findings report patient perspectives of the challenges and benefits of attending a PR programme along with recommendations on how the service could be improved. RESEARCH LIMITATIONS/IMPLICATIONS The authors focussed solely on a UK PR programme, so the findings might not be applicable to other countries if PR is organised and provided in a unique way or setting. PRACTICAL IMPLICATIONS This paper provides valuable insights to patient perspectives offrom patients attending PR programmes, which are useful to those running and designing these services. ORIGINALITY/VALUE The findings identify the benefits and challenges for patients attending PR programmes and suggest areas where improvements can be made.
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Affiliation(s)
- Sharon Williams
- College of Human and Health Sciences, Swansea University , Swansea, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham , Birmingham, UK.,Heart of England NHS Foundation Trust, Birmingham, UK
| | - Helen Beadle
- Heart of England NHS Foundation Trust, Birmingham, UK
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Twist K, Ablett J, Wearden A, Paine P, Vasant D, Lal S, Peters S. Gastrointestinal dysmotility: A qualitative exploration of the journey from symptom onset to diagnosis. Neurogastroenterol Motil 2018; 30:e13339. [PMID: 29575415 DOI: 10.1111/nmo.13339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/15/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal dysmotility (GID) covers a spectrum of disorders disrupting enteric neuromuscular co-ordination which, when severe, causes intractable gastrointestinal symptoms and malnutrition and is a recognized cause of chronic intestinal failure. To date, no study has provided an in-depth account of the experiences of patients with severe GID and their psychosocial needs. This study aimed to explore patients' experiences from symptom onset and the process of seeking and receiving a diagnosis. It specifically explored the psychological effect of this process and the effect on relationships. METHODS Participants (n = 20, mean age = 47.9, female n = 16, parenteral nutrition = 13) were recruited from a UK center with tertiary Neurogastroenterology and Intestinal Failure services. A qualitative exploratory design with semi-structured in-depth interviews was used. Data were analyzed using thematic analysis. KEY RESULTS Significant delays were experienced in obtaining a diagnosis. Participants reported having their mental health questioned and felt that they had to fight to prove their symptoms had a physical basis to access appropriate treatment. Although a diagnosis helped legitimize symptoms, the condition remained poorly understood by participants themselves, relatives, and health professionals. Participants discussed the impact that "feeling delegitimized" and the "lack of coherent understanding of GID" had on their relationships and mental health. CONCLUSIONS & INFERENCES The distressing experience of GID symptoms are compounded by a delay in validating symptoms and lack of coherent understanding. More knowledge of GID is needed by health professionals to speed up diagnosis and offer more coherent information. The psychological impact of a GID diagnosis should be acknowledged early to help facilitate adjustment.
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Affiliation(s)
- K Twist
- University of Manchester, Manchester, UK
| | - J Ablett
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Wearden
- University of Manchester, Manchester, UK
| | - P Paine
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - D Vasant
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Lal
- Salford Royal NHS Foundation Trust, Manchester, UK
| | - S Peters
- University of Manchester, Manchester, UK
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12
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Picariello F, Ali S, Foubister C, Chalder T. 'It feels sometimes like my house has burnt down, but I can see the sky': A qualitative study exploring patients' views of cognitive behavioural therapy for chronic fatigue syndrome. Br J Health Psychol 2017; 22:383-413. [PMID: 28349621 DOI: 10.1111/bjhp.12235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cognitive behavioural therapy (CBT) is currently a first-line treatment for chronic fatigue syndrome (CFS). Even though the results from trials are promising, there is variability in patient outcomes. The aim of this study was to explore the experiences of patients with CFS who undertook CBT at a specialist service for CFS. DESIGN This was a qualitative study. METHODS Thirteen patients with CFS, approaching the end of CBT, participated in semi-structured interviews. In addition, participants were asked to rate their satisfaction with CBT and perceived level of improvement. The data were analysed using inductive thematic analysis. RESULTS The majority of participants were satisfied with treatment and reported marked improvements. This was evident from the ratings and corroborated by the qualitative data, yet recovery was in general incomplete. Participants often disclosed mixed feelings towards CBT prior to its start. Behavioural aspects of treatment were found useful, while participants were more ambivalent towards the cognitive aspects of treatment. The tailored nature of CBT and therapist contact were important components of treatment, which provided participants with support and validation. Engagement and motivation were crucial for participants to benefit from CBT, as well as the acceptance of a bio-psychosocial model of CFS. Illness beliefs around CFS were also discussed throughout the interviews, possibly impeding engagement with therapy. CONCLUSIONS The results suggest that various factors may moderate the effectiveness of CBT, and a greater understanding of these factors may help to maximize benefits gained from CBT. Statement of contribution What is already known on this subject? CBT is effective in reducing CFS symptoms, but not all patients report marked improvements following treatment. Predictors of outcome have been explored in the literature. Few studies have looked at the experience of adult patients with CFS who have had CBT. What does this study add? Findings provide insights as to why variability in CBT-related improvements exists. Beliefs about CFS and CBT may shape engagement and consequently contribute to post-treatment outcomes. Flexibility and sensitivity are necessary from therapists throughout treatment to ensure full engagement.
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Affiliation(s)
- Federica Picariello
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sheila Ali
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Caroline Foubister
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Friedberg F. Cognitive-behavior therapy: why is it so vilified in the chronic fatigue syndrome community? FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2016. [DOI: 10.1080/21641846.2016.1200884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Noyes J, Hendry M, Lewin S, Glenton C, Chandler J, Rashidian A. Qualitative "trial-sibling" studies and "unrelated" qualitative studies contributed to complex intervention reviews. J Clin Epidemiol 2016; 74:133-43. [PMID: 26775628 DOI: 10.1016/j.jclinepi.2016.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 12/23/2015] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the contribution of "trial-sibling" and "unrelated" qualitative studies in complex intervention reviews. STUDY DESIGN AND SETTING Researchers are using qualitative "trial-sibling" studies undertaken alongside trials to provide explanations to understand complex interventions. In the absence of qualitative "trial-sibling" studies, it is not known if qualitative studies "unrelated" to trials are helpful. Trials, "trial-sibling," and "unrelated" qualitative studies looking at three health system interventions were identified. We looked for similarities and differences between the two types of qualitative studies, such as participants, intervention delivery, context, study quality and reporting, and contribution to understanding trial results. RESULTS Reporting was generally poor in both qualitative study types. We detected no substantial differences in participant characteristics. Interventions in qualitative "trial-sibling" studies were delivered using standardized protocols, whereas interventions in "unrelated" qualitative studies were delivered in routine care. Qualitative "trial-sibling" studies alone provided insufficient data to develop meaningful transferrable explanations beyond the trial context, and their limited focus on immediate implementation did not address all phenomena of interest. Together, "trial-sibling" and "unrelated" qualitative studies provided larger, richer data sets across contexts to better understand the phenomena of interest. CONCLUSIONS Findings support inclusion of "trial-sibling" and "unrelated" qualitative studies to explore complexity in complex intervention reviews.
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Affiliation(s)
- Jane Noyes
- School of Social Sciences, Bangor University, Bangor, LL57 2EF, UK.
| | - Margaret Hendry
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham LL13 7YP, UK
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape, PO Box 190707505 Tygerberg, South Africa
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Jackie Chandler
- The Cochrane Editorial Unit, Cochrane Central Executive, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK
| | - Arash Rashidian
- Department of Health Management and Economics, Tehran University of Medical Science, Tehran, Iran
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Sohanpal R, Steed L, Mars T, Taylor SJC. Understanding patient participation behaviour in studies of COPD support programmes such as pulmonary rehabilitation and self-management: a qualitative synthesis with application of theory. NPJ Prim Care Respir Med 2015; 25:15054. [PMID: 26379121 PMCID: PMC4588031 DOI: 10.1038/npjpcrm.2015.54] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), the problem of poor patient participation in studies of self-management (SM) and pulmonary rehabilitation (PR) programmes (together referred to as COPD support programmes) is established. Understanding this problem beyond the previously reported socio-demographics and clinical factors is critical. AIMS The aim of this study was to explore factors that explain patient participation in studies of COPD support programmes. METHODS Thematic 'framework' synthesis was conducted on literature published from 1984 to 1 February 2015. Emergent themes and subthemes were mapped onto the adapted 'attitude-social influence-external barriers' and the 'self-regulation' models to produce analytical themes. RESULTS Ten out of 12 studies were included: PR (n=9) and SM (n=1). Three descriptive themes with 38 subthemes were mapped onto the models' constructs, and it generated four analytical themes: 'attitude', 'social influences' and 'illness' and 'intervention representations'. The following factors influenced (1) attendance-helping oneself through health improvements, perceived control of worsening condition, perceived benefits and positive past experience of the programme, as well as perceived positive influence of professionals; (2) non-attendance-perceived negative effects and negative past experience of the programme, perceived physical/practical concerns related to attendance, perceived severity of condition/symptoms and perceived negative influence of professionals/friends; (3) dropout-no health improvements perceived after attending a few sessions of the programme, perceived severity of the condition and perceived physical/practical concerns related to attendance. CONCLUSIONS Psychosocial factors including perceived practical/physical concerns related to attendance influenced patients' participation in COPD support programmes. Addressing the negative beliefs/perceptions via behaviour change interventions may help improve participation in COPD support programmes and, ultimately, patient outcomes.
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Affiliation(s)
- Ratna Sohanpal
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liz Steed
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Thomas Mars
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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McCrae N, Correa A, Chan T, Jones S, de Lusignan S. Long-term conditions and medically-unexplained symptoms: feasibility of cognitive behavioural interventions within the improving access to Psychological Therapies Programme. J Ment Health 2015; 24:379-84. [PMID: 26360913 DOI: 10.3109/09638237.2015.1022254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Improving access to psychological therapies (IAPT) is a major programme in England to treat common mental health problems, mainly through cognitive behaviour therapy. In 2012, a Pathfinder scheme was launched to develop interventions for people with chronic physical health conditions or medically-unexplained symptoms. AIM This qualitative component of the evaluation investigated feasibility and acceptability of IAPT provision for people with enduring physical health problems. METHOD Qualitative interviews were conducted with project leaders in all 14 Pathfinder sites. FINDINGS Various therapeutic and training interventions were introduced. Most patients received low-intensity, structured therapy, with high-intensity input provided by some Pathfinders for complex cases. Whether the focus was on psychological symptoms or on broader well-being, psychiatric terminology was avoided to improve utilisation. Participants perceived high satisfaction among service-users. Training needs were indicated for IAPT workers in this specialised work. CONCLUSIONS Cognitive behaviour interventions appeared to be acceptable for people struggling with physical health problems. Robust outcome evidence will be pursued in Phase II.
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Affiliation(s)
- Niall McCrae
- a Florence Nightingale School of Nursing & Midwifery, King's College London , London , UK and
| | - Ana Correa
- b Department of Health Care Management & Policy , University of Surrey , Guildford , Surrey , UK
| | - Tom Chan
- b Department of Health Care Management & Policy , University of Surrey , Guildford , Surrey , UK
| | - Simon Jones
- b Department of Health Care Management & Policy , University of Surrey , Guildford , Surrey , UK
| | - Simon de Lusignan
- b Department of Health Care Management & Policy , University of Surrey , Guildford , Surrey , UK
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Patients with medically unexplained physical symptoms experience of receiving treatment in a primary-care psychological therapies service: a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2015. [DOI: 10.1017/s1352465815000235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAs a pilot site under the primary-care Increasing Access to Psychological Therapies (IAPT) Long Term Condition/Medically Unexplained Physical Symptoms (MUPS) project, patients with MUPS were offered cognitive behaviour therapy (CBT)-based treatments or attendance at a mindfulness-based stress reduction (MBSR) programme. This study aimed to gain an understanding of the views and experiences of MUPS patients that received CBT-based therapy or MBSR within an IAPT service and to investigate the relationship between their experiences and health outcomes measured on self-report questionnaires. Thematic analysis was used to analyse data gathered via semi-structured interviews with 11 patients. Data collected from three self-report measures were considered in relation to key features of participants’ reported experiences and patterns identified. Four main themes emerged: (1) something needs to change; (2) making connections between physical symptoms and mood, thoughts or activities; (3) sharing experiences and feeling understood; and (4) reflections on treatment experience. Participants generally reported a positive experience of treatment and felt better able to cope with their symptoms, although treatment did not necessarily result in reliable change in symptoms as measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Work and Social Adjustment Scale (WSAS). This novel model of treatment appears to be acceptable for this patient group although evaluation of the pilot should consider the ability of routinely used measures to capture the value of treatment to patients, including improved coping with symptoms.
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Ree E, Harris A, Indahl A, Tveito TH, Malterud K. How can a brief intervention contribute to coping with back pain? A focus group study about participants’ experiences. Scand J Public Health 2014; 42:821-6. [DOI: 10.1177/1403494814554029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants’ perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.
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Affiliation(s)
- Eline Ree
- Uni Research Health, Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Norway
| | - Anette Harris
- Department of Health Promotion and Development, University of Bergen, Norway
| | - Aage Indahl
- Uni Research Health, Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Norway
| | - Torill H. Tveito
- Uni Research Health, Bergen, Norway
- Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Norway
| | - Kirsti Malterud
- Uni Research Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Norway
- Research Unit for General Practice in Copenhagen, Denmark
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Bayliss K, Goodall M, Chisholm A, Fordham B, Chew-Graham C, Riste L, Fisher L, Lovell K, Peters S, Wearden A. Overcoming the barriers to the diagnosis and management of chronic fatigue syndrome/ME in primary care: a meta synthesis of qualitative studies. BMC FAMILY PRACTICE 2014; 15:44. [PMID: 24606913 PMCID: PMC3973969 DOI: 10.1186/1471-2296-15-44] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/18/2014] [Indexed: 11/13/2022]
Abstract
BACKGROUND The NICE guideline for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) emphasises the need for an early diagnosis in primary care with management tailored to patient needs. However, GPs can be reluctant to make a diagnosis and are unsure how to manage people with the condition. METHODS A meta synthesis of published qualitative studies was conducted, producing a multi-perspective description of barriers to the diagnosis and management of CFS/ME, and the ways that some health professionals have been able to overcome them. Analysis provided second-order interpretation of the original findings and developed third-order constructs to provide recommendations for the medical curriculum. RESULTS Twenty one qualitative studies were identified. The literature shows that for over 20 years health professionals have reported a limited understanding of CFS/ME. Working within the framework of the biomedical model has also led some GPs to be sceptical about the existence of the condition. GPs who provide a diagnosis tend to have a broader, multifactorial, model of the condition and more positive attitudes towards CFS/ME. These GPs collaborate with patients to reach agreement on symptom management, and use their therapeutic skills to promote self care. CONCLUSIONS In order to address barriers to the diagnosis and management of CFS/ME in primary care, the limitations of the biomedical model needs to be recognised. A more flexible bio-psychosocial approach is recommended where medical school training aims to equip practitioners with the skills needed to understand, support and manage patients and provide a pathway to refer for specialist input.
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Affiliation(s)
- Kerin Bayliss
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Mark Goodall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Anna Chisholm
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Beth Fordham
- Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Primary Care and Health Sciences and National School for Primary Care Research, Keele University, Keele, UK
| | - Lisa Riste
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Louise Fisher
- National School for Primary Care Research, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Alison Wearden
- School of Psychological Sciences, University of Manchester, Manchester, UK
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Brooks J, King N, Wearden A. Couples' experiences of interacting with outside others in chronic fatigue syndrome: a qualitative study. Chronic Illn 2014; 10:5-17. [PMID: 23585635 DOI: 10.1177/1742395312474478] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Social isolation and stigma are frequently reported by patients with chronic fatigue syndrome/myalgic encephalomyelitis and relationships in the home environment with those close to the patients (their 'significant others') may thus be particularly important. Rather little attention has yet been paid to the beliefs and experiences of 'significant others' themselves in this context. This study sought to explore in-depth the beliefs and experiences of both patients and 'significant others' in relation to chronic fatigue syndrome/myalgic encephalomyelitis. METHODS In-depth interviews using a semi-structured interview schedule designed around the core constructs of the Common-Sense Model of self-regulation were conducted with two patients with chronic fatigue syndrome/myalgic encephalomyelitis and their spouses. Interpretative Phenomenological Analysis was used to analyse interview data. RESULTS Experiences of social interactions in relation to chronic fatigue syndrome/myalgic encephalomyelitis with others outside of the relationship dyad emerged as a key issue for all participants when reflecting on their experiences of living with the condition. These concerns are presented under two themes: interactions with healthcare professionals and interactions with the social world. CONCLUSIONS It is evident that significant others play an important role in the lived experience of chronic fatigue syndrome/myalgic encephalomyelitis. For both patients and significant others, the wider social world and interactions with outside others may be important influences on dyadic coping in chronic fatigue syndrome/myalgic encephalomyelitis. Both future research and treatment interventions could usefully include a 'significant other' perspective.
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Affiliation(s)
- Joanna Brooks
- 1Centre for Applied Psychological Research, University of Huddersfield, UK
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Rosendal M, Blankenstein AH, Morriss R, Fink P, Sharpe M, Burton C. Enhanced care by generalists for functional somatic symptoms and disorders in primary care. Cochrane Database Syst Rev 2013:CD008142. [PMID: 24142886 DOI: 10.1002/14651858.cd008142.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with medically unexplained or functional somatic symptoms are common in primary care. Previous reviews have reported benefit from specialised interventions such as cognitive behavioural therapy and consultation letters, but there is a need for treatment models which can be applied within the primary care setting. Primary care studies of enhanced care, which includes techniques of reattribution or cognitive behavioural therapy, or both, have shown changes in healthcare professionals' attitudes and behaviour. However, studies of patient outcome have shown variable results and the value of enhanced care on patient outcome remains unclear. OBJECTIVES We aimed to assess the clinical effectiveness of enhanced care interventions for adults with functional somatic symptoms in primary care. The intervention should be delivered by professionals providing first contact care and be compared to treatment as usual. The review focused on patient outcomes only. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised Register (CCDANCTR-Studies and CCDANCTR-References) (all years to August 2012), together with Ovid searches (to September 2012) on MEDLINE (1950 - ), EMBASE (1980 - ) and PsycINFO (1806 - ). Earlier searches of the Database of Abstracts of Reviews of Effectiveness (DARE), CINAHL, PSYNDEX, SIGLE, and LILACS were conducted in April 2010, and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2009. No language restrictions were applied. Electronic searches were supplemented by handsearches of relevant conference proceedings (2004 to 2012), reference lists (2011) and contact with authors of included studies and experts in the field (2011). SELECTION CRITERIA We limited our literature search to randomised controlled trials (RCTs), primary care, and adults with functional somatic symptoms. Subsequently we selected studies including all of the following: 1) a trial arm with treatment as usual; 2) an intervention using a structured treatment model which draws on explanations for symptoms in broad bio-psycho-social terms or encourages patients to develop additional strategies for dealing with their physical symptoms, or both; 3) delivery of the intervention by primary care professionals providing first contact care; and 4) assessment of patient outcome. DATA COLLECTION AND ANALYSIS Two authors independently screened identified study abstracts. Disagreements about trial selections were resolved by a third review author. Data from selected publications were independently extracted and risk of bias assessed by two of three authors, avoiding investigators reviewing their own studies. We contacted authors from included studies to obtain missing information. We used continuous outcomes converted to standardised mean differences (SMDs) and based analyses on changes from baseline to follow-up, adjusted for clustering. MAIN RESULTS We included seven studies from the literature search, but only six provided sufficient data for analyses. Included studies were European, cluster RCTs with adult participants seeing their usual doctor (in total 233 general practitioners and 1787 participants). Methodological quality was only moderate as studies had no blinding of healthcare professionals and several studies had a risk of recruitment and attrition bias. Studies were heterogeneous with regard to selection of patient populations and intensity of interventions. Outcomes relating to physical or general health (physical symptoms, quality of life) showed substantial heterogeneity between studies (I(2) > 70%) and post hoc analysis suggested that benefit was confined to more intensive interventions; thus we did not calculate a pooled effect. Outcomes relating to mental health showed less heterogeneity and we conducted meta-analyses, which found non-significant overall effect sizes with SMDs for changes at 6 to 24 months follow-up: mental health (3 studies) SMD -0.04 (95% CI -0.18 to 0.10), illness worry (3 studies) SMD 0.09 (95% CI -0.04 to 0.22), depression (4 studies) SMD 0.07 (95% CI -0.05 to 0.20) and anxiety (2 studies) SMD -0.07 (95% CI -0.38 to 0.25). Effects on sick leave could not be estimated. Three studies of patient satisfaction with care all showed positive but non-significant effects, and measures were too heterogeneous to allow meta-analysis. Results on healthcare utilisation were inconclusive. We analysed study discontinuation and found that both short term and long term discontinuation occurred more often in patients allocated to the intervention group, RR of 1.25 (95% CI 1.08 to 1.46) at 12 to 24 months. AUTHORS' CONCLUSIONS Current evidence does not answer the question whether enhanced care delivered by front line primary care professionals has an effect or not on the outcome of patients with functional somatic symptoms. Enhanced care may have an effect when delivered per protocol to well-defined groups of patients with functional disorders, but this needs further investigation. Attention should be paid to difficulties including limited consultation time, lack of skills, the need for a degree of diagnostic openness, and patient resistance towards psychosomatic attributions. There is some indication from this and other reviews that more intensive interventions are more successful in changing patient outcomes.
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Affiliation(s)
- Marianne Rosendal
- Research Unit for General Practice, Institute of Public Health, Aarhus University, Bartholins Alle 2, Århus, Denmark, DK-8000
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Richardson G, Epstein D, Chew-Graham C, Dowrick C, Bentall RP, Morriss RK, Peters S, Riste L, Lovell K, Dunn G, Wearden AJ. Cost-effectiveness of supported self-management for CFS/ME patients in primary care. BMC FAMILY PRACTICE 2013; 14:12. [PMID: 23327355 PMCID: PMC3556109 DOI: 10.1186/1471-2296-14-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/07/2013] [Indexed: 12/03/2022]
Abstract
BACKGROUND Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. METHODS Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis. RESULTS Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population. CONCLUSIONS This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with 'treatment as usual' in primary care is unlikely to be acceptable to patients and practitioners. TRIAL REGISTRATION The trial registration number is IRCTN74156610.
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Affiliation(s)
- Gerry Richardson
- Centre for Health Economics, University of York, Hull/York Medical School, York, YO10 5DD, United Kingdom
| | - David Epstein
- Centre for Health Economics, University of York, Hull/York Medical School, York, YO10 5DD, United Kingdom
| | - Carolyn Chew-Graham
- School of Community Based Medicine, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Christopher Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Richard P Bentall
- School of Psychology, University of Bangor, Adeilad Brigantia, Penrallt Road, Bangor, Gwynedd, LL57 2AS, United Kingdom
| | - Richard K Morriss
- School of Community Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, United Kingdom
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Graham Dunn
- School of Community Based Medicine, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Alison J Wearden
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
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Peters S, Wearden A, Morriss R, Dowrick CF, Lovell K, Brooks J, Cahill G, Chew-Graham C. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis. Implement Sci 2011; 6:132. [PMID: 22192566 PMCID: PMC3259041 DOI: 10.1186/1748-5908-6-132] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 12/22/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs) is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME]) within a primary care setting. METHODS A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening) from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. RESULTS Analyses identified four sets of challenges that were common to both interventions: (i) being a novice therapist, (ii) engaging patients in the therapeutic model, (iii) dealing with emotions, and (iv) the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. CONCLUSIONS Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found for other LTCs. Our findings have implications for developing therapeutic alliances and highlight the need for regular supervision.
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Affiliation(s)
- Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Alison Wearden
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Richard Morriss
- School of Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Christopher F Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Joanna Brooks
- Centre for Applied Psychological Research, University of Huddersfield, Huddersfield, UK
| | - Greg Cahill
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK
| | - Carolyn Chew-Graham
- School of Community Based Medicine, University of Manchester, Manchester, UK
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