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Southern J, Elliott P, Maidment I. What are patients' experiences of discontinuing clozapine and how does this impact their views on subsequent treatment? BMC Psychiatry 2023; 23:353. [PMID: 37217959 DOI: 10.1186/s12888-023-04851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Discontinuing what is considered the most effective treatment for treatment-resistant schizophrenia may precipitate feelings of failure or a relapse of illness. Clozapine treatment is discontinued for a variety of reasons, including non-adherence, intolerance, or lack of efficacy. Patients' experiences of discontinuing the "best" treatment and the impact on perceptions of subsequent antipsychotic treatment are important in developing an understanding of the factors affecting people's treatment choices. This study is the first of its type, seeking to explore people's perspectives on clozapine discontinuation. METHOD Semi-structured interviews with sixteen patients who had received clozapine and discontinued treatment-thirteen males and three females, age range: thirty-two to seventy-eight years old-were audio-recorded and transcribed. A modified inductive approach to analysis, based on grounded theory, was taken to identify commonalities and differences in patients' perceptions. RESULTS The three main themes identified from participants' experiences were: (1) positive and negative effects of treatment; (2) feelings of agency, being the capacity to make decisions about treatment and act independently; (3) choice of treatment in the future. Participants exhibited agency in making choices about medication, including risking relapse, while attempting self-management of medication effects. Different participants perceived the same side effect as beneficial or intolerable. Variation in subsequent treatment choices was reported, with some participants favouring depot (long-acting) injections. A participant was frightened when not told about clozapine's side effects, which led to the participant not being engaged in future treatment decisions. Others, despite suffering serious adverse effects, retained positive perceptions of clozapine; they experienced despair at finding an effective alternative. CONCLUSIONS Experiences with clozapine discontinuation evoked powerful emotions and resulted in clozapine being the benchmark for other treatments. Knowledge, agency, and being in control were important to participants in relation to treatment. Personal perceptions of treatments or beliefs about illness could lead to non-adherence. People value the clinician listening to their experiences to better understand their perspective, enabling concerns about medication to be addressed through true shared decision making. TRIAL REGISTRATION NHS Health Research Authority and Health and Care Research Wales, IRAS Project ID 225753, Research Ethics Committee (REC) reference: 18/NW/0413, 25/06/2018.
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Affiliation(s)
- Jennifer Southern
- Aston University, Birmingham, B4 7ET, England.
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England.
| | - Phil Elliott
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England
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Kajikawa T, Araki T. A Qualitative Study on What It Means for Patients with Schizophrenia Living in the Community to Remain on Medication. Health (London) 2023. [DOI: 10.4236/health.2023.151006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Ko CJ, Huang HL, Gao ZT, Chiang HH. Re-figuration of suffering: Transitional phenomena of people living with schizophrenia in group analysis. Arch Psychiatr Nurs 2022; 39:13-19. [PMID: 35688539 DOI: 10.1016/j.apnu.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 02/03/2023]
Abstract
This study examined how people living with schizophrenia recognize their lived experiences in free-floating group discussions. Interpretative phenomenological and group analyses were employed to collect qualitative data from 14 patients. The identified superordinate theme was "re-figuration of suffering" including: "being treated as an object," "encountering the self through others," and "returning to the self." Participants shared their traumatizing stories of being alienated, discovered the realities of their lives and responsibilities through inward and outward observations, and progressed to a self-returning stage while regaining their appreciation of others and hope for the future. The contributions of psychiatric nursing practice were identified.
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Affiliation(s)
- Chen Ju Ko
- School of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan, ROC.
| | - Hseuh-Li Huang
- Department of Medical Education, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan, ROC
| | - Zih Ting Gao
- Department of Nursing, Tongxin Long-term Health Care Center, Taoyuan, Taiwan, ROC
| | - Hsien-Hsien Chiang
- School of Nursing, National Yang Ming Chiao Tung University, Taiwan, ROC.
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Pérez-Corrales J, Huertas-Hoyas E, García-Bravo C, Güeita-Rodríguez J, Palacios-Ceña D. Volunteering as a Meaningful Occupation in the Process of Recovery From Serious Mental Illness: A Qualitative Study. Am J Occup Ther 2022; 76:23213. [PMID: 35201298 DOI: 10.5014/ajot.2022.045104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community. OBJECTIVE To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work. DESIGN Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis. SETTING Several mental health community centers in Madrid and Catalonia, Spain. PARTICIPANTS People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data. RESULTS Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering). CONCLUSIONS AND RELEVANCE Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process.
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Affiliation(s)
- Jorge Pérez-Corrales
- Jorge Pérez-Corrales, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Elisabet Huertas-Hoyas
- Elisabet Huertas-Hoyas, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain;
| | - Cristina García-Bravo
- Cristina García-Bravo, MSc, OTR, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group in Evaluation and Assessment of Capacity, Functionality and Disability, Universidad Rey Juan Carlos, Madrid, Spain
| | - Javier Güeita-Rodríguez
- Javier Güeita-Rodríguez, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Domingo Palacios-Ceña
- Domingo Palacios-Ceña, PhD, is Professor, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Research Group of Humanities and Qualitative Research in Health Science, Universidad Rey Juan Carlos, Madrid, Spain
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Aceituno D, Pennington M, Iruretagoyena B, Matthew Prina A, McCrone P. Author's Reply. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:603. [PMID: 33840440 DOI: 10.1016/j.jval.2020.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- David Aceituno
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, England, UK.
| | - Mark Pennington
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, England, UK
| | - Barbara Iruretagoyena
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, England, UK
| | - A Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, England, UK
| | - Paul McCrone
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, London, England, UK
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Lambert M, Sanchez P, Bergmans P, Gopal S, Mathews M, Wooller A, Pungor K. Effect of Paliperidone Palmitate 3-Month Formulation on Goal Attainment and Disability After 52 Weeks' Treatment in Patients with Clinically Stable Schizophrenia. Neuropsychiatr Dis Treat 2020; 16:3197-3208. [PMID: 33380797 PMCID: PMC7767727 DOI: 10.2147/ndt.s286654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/08/2020] [Indexed: 01/09/2023] Open
Abstract
PURPOSE This pragmatic clinical study aimed to assess goal attainment among patients with schizophrenia treated with paliperidone palmitate 3-monthly (PP3M) and its relation to their level of disability, and whether patients achieved symptomatic remission at the study endpoint. PATIENTS AND METHODS Goal attainment was assessed as a secondary endpoint using Goal Attainment Scaling (GAS) within a 52-week, prospective, single-arm, non-randomized, open-label, international, multicenter study evaluating the impact of transitioning stable patients with schizophrenia from paliperidone palmitate 1-monthly (PP1M) to PP3M. Additional exploratory analyses were performed to investigate the relationship between disability and functioning as measured by the World Health Organization Disability Assessment Schedule (WHODAS), Version 2.0, symptomatic remission, and goal attainment. RESULTS Overall, 305 patients were enrolled, of whom 281 (92.1%) provided GAS data at baseline. Of these, 160 achieved symptomatic remission at the last observation carried forward (LOCF) endpoint. The most common category of goals was "self" related, of which work-related was most frequent. Two-thirds of patients (67.7%) achieved at least one goal at the LOCF endpoint. Goal achievement was positively associated with lower baseline symptoms and symptomatic remission at LOCF endpoint, and with lower WHODAS scores at baseline and LOCF endpoint and greater WHODAS score improvements from baseline. Age, duration of disease, and duration of PP1M treatment before the switch did not impact goal setting and goal attainment. The proportion of patients with remunerated work status increased by 11.3% at LOCF endpoint. CONCLUSION The results of this secondary endpoint analysis indicate that continued treatment of patients with schizophrenia with PP3M following stabilization with PP1M may facilitate attainment of patients' personal goals and reduce disability, especially, but not exclusively, in patients with symptomatic remission achieved at LOCF.
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Affiliation(s)
- Martin Lambert
- Centre for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pedro Sanchez
- Treatment Resistant Psychosis Unit, Hospital Psiquiatrico De Álava, Osakidetza, Vitoria, Spain
- School of Medicine, University of Deusto, Bilbao, Spain
| | - Paul Bergmans
- Janssen-Cilag B.V., Biostatistics, Breda, Netherlands
| | | | - Maju Mathews
- Janssen Pharma, Global Medical Affairs, New York City, NY, USA
| | | | - Katalin Pungor
- Janssen Medical Affairs EMEA, Janssen-Cilag GmbH. Johnson and Johnson Platz 1, 41470 Neuss, Germany
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Assessment of Real-Life Outcomes in Schizophrenia Patients according to Compliance. PSYCHIATRY JOURNAL 2020; 2020:5848601. [PMID: 32934955 PMCID: PMC7479455 DOI: 10.1155/2020/5848601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 11/18/2022]
Abstract
Objective To describe and compare demographics, outcomes and comorbidities in schizophrenia patients by treatment compliance. Methods This was a cross-sectional survey of hospital- or office-based psychiatrists who saw ≥6 schizophrenia patients per week and were responsible for treatment decisions. Recruited physicians completed a patient record form (PRF) for their first 10 consulted schizophrenia patients aged ≥18. These patients voluntarily completed a patient self-completion form (PSC). Compliance was measured by subjective physician assessment. Drivers of and outcomes associated with compliance were identified by regression analyses. Results A total of 150 physicians completed PRFs for 1489 patients (706 sometimes compliant (SC), 636 always compliant (AC)). A total of 680 patients completed a PSC (327 SC, 295 AC). AC patients were less likely to be male (52.2% vs. 58.6%; P = 0.021) and unemployed (odds ratio (OR) 0.91, 95% confidence interval (CI) 0.82-1.00; P < 0.001) or to have had a treatment regimen change (OR 0.56, 95% CI 0.40-0.80; P = 0.001) than SC patients. AC patients were less likely to have had more comorbidities (OR 0.91, 95% CI 0.82-1.00; P = 0.045) and hospitalizations in the past 12 months (OR 0.59, 95% CI 0.43-0.80; P = 0.001) than SC patients. Overall, AC patients had better clinical and humanistic outcomes. Weight gain was a common side effect for all patients; SC patients with weight gain had poorer outcomes than those without weight gain. Conclusion Schizophrenia patients that were SC experienced poorer clinical outcomes and quality of life. Weight gain may exacerbate these poorer outcomes.
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Well-Being and Self-Disorders in Schizotypal Disorder and Asperger Syndrome/Autism Spectrum Disorder. J Nerv Ment Dis 2020; 208:418-423. [PMID: 31977719 DOI: 10.1097/nmd.0000000000001145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We explored subjective well-being in two groups of young adult participants diagnosed with either schizotypal disorder (Sd) (n = 29) or Asperger syndrome/autism spectrum disorder (As/ASD) (n = 22). Well-being was impaired in both groups and was lower in the Sd group than in the As/ASD group. Furthermore, there was a negative correlation between well-being and the presence of self-disorders. The negative effect of self-disorders on well-being was still significant when adjusted for diagnosis, age and gender, and level of function. The present findings point toward clinically important disorder-specific differences in the nature of impaired well-being between the Sd group and the As/ASD group, as there seems to be a self-disorder-driven additional contribution to impaired subjective well-being within the schizophrenia spectrum. These findings further nuance the understanding of fundamental and clinically important qualitative differences between the schizophrenia spectrum and the autism spectrum.
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Houdayer F, Putois O, Babonneau ML, Chaumet H, Joly L, Juif C, Michon CC, Staraci S, Cretin E, Delanoue S, Charron P, Chassagne A, Edery P, Gautier E, Lapointe AS, Thauvin-Robinet C, Sanlaville D, Gargiulo M, Faivre L. Secondary findings from next generation sequencing: Psychological and ethical issues. Family and patient perspectives. Eur J Med Genet 2019; 62:103711. [PMID: 31265899 DOI: 10.1016/j.ejmg.2019.103711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 06/04/2019] [Accepted: 06/28/2019] [Indexed: 01/25/2023]
Abstract
Access to active search for actionable secondary findings (SF) in diagnostic practice is a major psychological and ethical issue for genomic medicine. In this study, we analyzed the preferences of patients and their families regarding SF and identified the reporting procedures necessary for informed consent. We interviewed parents of patients with undiagnosed rare diseases potentially eligible for exome sequencing and patients affected by the diseases listed in the ACMG recommendations. Four focus groups (FG) were formed: parents of patients with undiagnosed rare diseases (FG1, n = 5); patients with hereditary cancers (FG2, n = 10); patients with hereditary cardiac conditions (FG3, n = 3); and patients with metabolic diseases (FG4, n = 3). Psychologists presented three broad topics for discussion: 1. Favorable or not to SF access, 2. Reporting procedures, 3. Equity of access. Discussions were recorded and analyzed using simplified Grounded Theory. Overall, 8 participants declared being favorable to SF because of the medical benefit (mainly FG1); 11 were unfavorable because of the psychological consequences (mainly FG2, FG3, FG4); 2 were ambivalent. The possibility of looking for SF in minors was debated. The 4 key information-based issues for participants ranked as follows: explanation of SF issues, autonomy of choice, importance of a reflection period, and quality of interactions between patients and professionals. Examining equity of access to SF led to philosophical discussions on quality of life. In conclusion, individual experience and life context (circumstances) were decisive in participants' expectations and fears regarding access to SF. Additional longitudinal studies based on actual SF disclosure announcements are needed to establish future guidelines.
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Affiliation(s)
- F Houdayer
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; Université de Paris, PCPP, F-92100 Boulogne-Billancourt, France
| | - O Putois
- SuLiSoM EA 3071, Univ. Strasbourg, France; Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | | | - H Chaumet
- Genetics Department, Oncogenetics, HCL, Bron, France
| | - L Joly
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | - C Juif
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | - C C Michon
- Filière Cardiogen, GH APHP, Paris, France
| | - S Staraci
- Genetics Department, Reference Centre for Hereditary Cardiac Disorders, GH APHP, Paris, France; Clinical Psychology Laboratory, Psychopathology, Psychoanalysis (EA4056), Univ. Paris Descartes, Sorbonne Paris Cité, France
| | - E Cretin
- CIC, 1431 INSERM, CHU Besançon, France; Philosophy Laboratory « Logiques de l'Agir » EA2274, Univ. Bourgogne Franche-Comté, Besançon, France
| | | | - P Charron
- Filière Cardiogen, GH APHP, Paris, France; Genetics Department, Reference Centre for Hereditary Cardiac Disorders, GH APHP, Paris, France
| | - A Chassagne
- CIC, 1431 INSERM, CHU Besançon, France; FHU TRANSLAD, Dijon University Hospital, France
| | - P Edery
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, Univ. Claude Bernard Lyon 1, Bron, France
| | - E Gautier
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France
| | | | - C Thauvin-Robinet
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France; FHU TRANSLAD, Dijon University Hospital, France
| | - D Sanlaville
- Genetics Department, Reference Centre for Developmental Disorders Centre East, HCL, Bron, France; INSERM U1028, CNRS UMR5292, CRNL, GENDEV Team, Univ. Claude Bernard Lyon 1, Bron, France
| | - M Gargiulo
- Université de Paris, PCPP, F-92100 Boulogne-Billancourt, France; Institute of Myology, GH APHP, Paris, France
| | - L Faivre
- Genetics Department, The Centre of Reference for Rare Diseases East, Dijon University Hospital, France; FHU TRANSLAD, Dijon University Hospital, France.
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Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies. J Ment Health 2019; 29:513-523. [DOI: 10.1080/09638237.2019.1581352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina O. Lavik
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | | | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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Happell B, Gordon S, Bocking J, Ellis P, Roper C, Liggins J, Scholz B, Platania-Phung C. Turning the Tables: Power Relations Between Consumer Researchers and Other Mental Health Researchers. Issues Ment Health Nurs 2018; 39:633-640. [PMID: 29847183 DOI: 10.1080/01612840.2018.1445328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A crucial development resulting from consumer involvement in mental health services has been engagement as active participants in mental health research, often conducted in collaboration with mental health researchers representing the health disciplines (referred to in this paper as 'other' researchers). Despite progress in mental health consumer research, unequal power relations continue to pose a major barrier. Although power issues are discussed in the literature, there is little research from the perspective of other mental health researchers who have collaborated with consumers on research projects. This qualitative study explored other mental health researchers' perspectives on the role of power in collaborative research with consumers. Semi-structured interviews were completed with 11 other mental health researchers. Thematic analysis of the transcript version of interview recordings was conducted. The findings were grounded in 'the table' as a literal and metaphorical site of power relations. The umbrella theme was prominence and presence (of consumers) at the table, followed by subthemes on barriers (tokenism, undermined potential) and surmounting them through reworking power (critical mass and openness to power dynamics). Overall it was found that while there continue to be significant power-related barriers to further building of robust collaborative research with consumers in mental health, there are several avenues that should be considered, much more assertively, to disrupt and transcend them.
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Affiliation(s)
- Brenda Happell
- a SYNERGY: Nursing and Midwifery Research Centre University of Canberra and ACT Health , WODEN , Australia
| | - Sarah Gordon
- b Department of Psychological Medicine , School of Medicine and Health Sciences, University of Otago , Wellington , Wellington South , New Zealand
| | - Julia Bocking
- a SYNERGY: Nursing and Midwifery Research Centre University of Canberra and ACT Health , WODEN , Australia
| | - Pete Ellis
- b Department of Psychological Medicine , School of Medicine and Health Sciences, University of Otago , Wellington , Wellington South , New Zealand
| | - Cath Roper
- c Centre for Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences , The University of Melbourne , Victoria
| | - Jackie Liggins
- d University of Auckland , St Johns , Auckland , New Zealand
| | - Brett Scholz
- a SYNERGY: Nursing and Midwifery Research Centre University of Canberra and ACT Health , WODEN , Australia
| | - Chris Platania-Phung
- a SYNERGY: Nursing and Midwifery Research Centre University of Canberra and ACT Health , WODEN , Australia
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Horrell J, Lloyd H, Sugavanam T, Close J, Byng R. Creating and facilitating change for Person-Centred Coordinated Care (P3C): The development of the Organisational Change Tool (P3C-OCT). Health Expect 2018; 21:448-456. [PMID: 29139220 PMCID: PMC5867330 DOI: 10.1111/hex.12631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Person Centred Coordinated Care (P3C) is a UK priority for patients, carers, professionals, commissioners and policy makers. Services are developing a range of approaches to deliver this care with a lack of tools to guide implementation. METHODOLOGY A scoping review and critical examination of current policy, key literature and NHS guidelines, together with stakeholder involvement led to the identification of domains, subdomains and component activities (processes and behaviours) required to deliver P3C. These were validated through codesign with stakeholders via a series of workshops and cognitive interviews. RESULTS Six core domains of P3C were identified as follows: (i) my goals, (ii) care planning, (iii) transitions, (iv) decision making (v), information and communication and (vi) organizational support activities. These were populated by 29 core subdomains (question items). A number of response codes (components) to each question provide examples of the processes and activities that can be actioned to achieve each core subdomain of P3C. CONCLUSION The P3C-OCT provides a coherent approach to monitoring progress and supporting practice development towards P3C. It can be used to generate a shared understanding of the core domains of P3C at a service delivery level, and support reorganization of care for those with complex needs. The tool can reliably detect change over time, as demonstrated in a sample of 40 UK general practices. It is currently being used in four UK evaluations of new models of care and being further developed as a training tool for the delivery of P3C.
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Affiliation(s)
- Jane Horrell
- Plymouth UniversityPeninsula Schools of Medicine and DentistryNIHR CLAHRC, South West Peninsula (PenCLAHRC)PlymouthUK
| | - Helen Lloyd
- Plymouth UniversityPeninsula Schools of Medicine and DentistryNIHR CLAHRC, South West Peninsula (PenCLAHRC)PlymouthUK
| | - Thavapriya Sugavanam
- Nuffield Department of OrthopaedicsRheumatology & Musculoskeletal Sciences (NDORMS)University of OxfordOxfordUK
| | - James Close
- Plymouth UniversityPeninsula Schools of Medicine and DentistryNIHR CLAHRC, South West Peninsula (PenCLAHRC)PlymouthUK
| | - Richard Byng
- Plymouth UniversityPeninsula Schools of Medicine and DentistryNIHR CLAHRC, South West Peninsula (PenCLAHRC)PlymouthUK
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Palacios-Ceña D, Martín-Tejedor EA, Elías-Elispuru A, Garate-Samaniego A, Pérez-Corrales J, García-García E. The impact of a short-term cohousing initiative among schizophrenia patients, high school students, and their social context: A qualitative case study. PLoS One 2018; 13:e0190895. [PMID: 29324773 PMCID: PMC5764336 DOI: 10.1371/journal.pone.0190895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background A number of programs have been developed to promote the contact between adolescents and mentally-ill patients, in order to break the stigma, improve understanding, promote mental health and prevent substance abuse. The aim of this study was to describe the experience of patients with schizophrenia, high school students, and their social context, participating in a short-term cohousing initiative. Methods A qualitative case-study approach was implemented. Patients with schizophrenia from the San Juan de Dios Psychiatric Hospital, female students from Almen High School, and participants from their social context (parents, hospital staff, and teachers) were included, using purposeful sampling. Data were collected from 51 participants (15 patients, nine students, 11 hospital staff, six teachers, 10 parents) via non-participant observation, focus groups, informal interviews, researchers’ field notes and patients’ personal diaries and letters. A thematic analysis was performed. Results The themes identified included a) learning to live together: students and patients participate and learn together; b) the perception of the illness and the mentally-ill: the barrier between health and disease is very slim, and society tends to avoid contact with those who are ill; c) change: a transformation takes place in students, in their self-perception, based on the real and intense nature of the experience; d) a trial and an opportunity: patients test their ability to live outside the hospital; e) discharge and readmission: discharge is experienced as both a liberation and a difficulty, whereas relapse and readmission are experienced as failures. Conclusions Our findings can help us to better understand schizophrenia and encourage a more positive approach towards both the illness and those who suffer from it. These results may be used for the development of cohousing programs in controlled environments.
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Affiliation(s)
- Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
- * E-mail:
| | | | - Ana Elías-Elispuru
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Amaia Garate-Samaniego
- Hospital Psiquiátrico San Juan de Dios Arrasate-Mondragón, Hermanos de San Juan de Dios, Arrasate, Spain
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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Potter CM, Kelly L, Hunter C, Fitzpatrick R, Peters M. The context of coping: a qualitative exploration of underlying inequalities that influence health services support for people living with long-term conditions. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:130-145. [PMID: 29023822 PMCID: PMC5846884 DOI: 10.1111/1467-9566.12624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coping with chronic illness encapsulates both practical and emotional aspects of living life in relation to one's long-term health condition(s). Dominant health psychology approaches for understanding coping, which underpin a more recent policy discourse on 'self-management', focus sharply on the person affected by illness and potentially mask the influence of overarching social structure. In this paper we draw on qualitative interviews with 48 people living with long-term conditions (LTCs), in order to highlight the role that structural configurations such as healthcare systems may play in either helping or hindering people's efforts to cope with chronic illness. We argue that coping is a social process in which health and related services, situated within their wider political-economic contexts, play an active role in shaping people's attempts to live well with LTCs. More specifically, health systems are sites of social and cultural capital exchange that can differentially mobilise coping resources through access, continuity of care, and coordination across services. Whilst it is essential to recognise the personal agency of people living with chronic illness, it is also vital to acknowledge the underlying inequalities that affect the ways in which services can support such resourcefulness.
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Affiliation(s)
- Caroline M. Potter
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Laura Kelly
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Cheryl Hunter
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Department of Health EnglandQORU: Quality and Outcomes of Person‐centred Care Policy Research UnitUK
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) OxfordOxfordUK
| | - Michele Peters
- Health Services Research Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
- Department of Health EnglandQORU: Quality and Outcomes of Person‐centred Care Policy Research UnitUK
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15
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Lloyd H, Lloyd J, Fitzpatrick R, Peters M. The role of life context and self-defined well-being in the outcomes that matter to people with a diagnosis of schizophrenia. Health Expect 2017; 20:1061-1072. [PMID: 28370942 PMCID: PMC5600238 DOI: 10.1111/hex.12548] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2017] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Conduct a deep exploration of the outcomes that matter to people with a diagnosis of schizophrenia and understand from their perspective how these outcomes can be achieved. SAMPLE AND METHODS In-depth qualitative interviews were conducted with 22 people with a diagnosis of schizophrenia. Interviews were analysed using thematic frameworks, and a realist informed theories of change approach. RESULTS Our study revealed the potential causal relationships between the context of a person's life, short-term goals and long-term outcomes. We provide a nuanced and detailed exploration of outcomes that matter for people with schizophrenia in relation to self-defined well-being. Achieving life milestones, feeling safe and outcomes related to improved physical health along with employment, a positive sense of self and psychosocial outcomes, were highly valued. For short- and long-term outcomes to be achieved, individuals required medication with minimal side-effects, cognitive behavioural therapy, family/social support and meaningful activities in their lives. Well-being was influenced by life context and short- and long-term outcomes, but in a circular nature also framed what short-term goals could be achieved. CONCLUSIONS Working with people with a diagnosis of schizophrenia to identify and achieve better outcomes will necessitate a person-centred approach. This will require an appreciation of the relationship between the statutory and non-statutory resources that are available and a consideration of an individual's current well-being status. This approach acknowledges personal strengths and encourages ownership of goals and supports self-management.
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Affiliation(s)
- Helen Lloyd
- Peninsula Medical SchoolPlymouth UniversityDevonUK
| | - Joanne Lloyd
- School of PsychologySport and ExerciseStaffordshire UniversityStoke on TrentUK
| | - Ray Fitzpatrick
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Michele Peters
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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16
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Lloyd J, Lloyd H, Fitzpatrick R, Peters M. Treatment outcomes in schizophrenia: qualitative study of the views of family carers. BMC Psychiatry 2017; 17:266. [PMID: 28732482 PMCID: PMC5521073 DOI: 10.1186/s12888-017-1418-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Schizophrenia is a complex, heterogeneous disorder, with highly variable treatment outcomes, and relatively little is known about what is important to patients. The aim of the study was to understand treatment outcomes informal carers perceive to be important to people with schizophrenia. METHOD Qualitative interview study with 34 individuals and 8 couples who care for a person with schizophrenia/schizoaffective disorder. Interviews were transcribed verbatim and analysed by a thematic framework based approach. RESULTS Carers described well-recognised outcomes of importance, alongside more novel outcomes relating to: Safety (of the patient/others); insight (e.g. into non-reality of psychotic phenomena); respite from fear, distress or pain; socially acceptable behaviour; getting out of the house; attainment of life milestones; changes in personality and/or temperament; reduction of vulnerability to stress; and several aspects of physical health. CONCLUSIONS These findings have the potential to inform the development of patient- or carer- focused outcome measures that take into account the full range of domains that carers feel are important for patients.
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Affiliation(s)
- Joanne Lloyd
- School of Psychology, Sport and Exercise, Staffordshire University, Stoke on Trent, UK
| | - Helen Lloyd
- Peninsula Medical School, Plymouth University, Plymouth, Devon UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF UK
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