Experiences and views of carers regarding the physical health care of people with severe mental illness: An integrative thematic review of qualitative research

The impact of providing care for physical health in severe mental illness on informal carers: a qualitative study

BACKGROUND

People with severe mental illness (SMI) such as schizophrenia and bipolar disorder are at a substantially higher risk of premature death in that they die between 10 and 20 years earlier than the general population. Cardiovascular disease (CVD) and diabetes are the main potentially avoidable contributors to early death. Research that explores the experiences of people with SMI highlights their struggles in engaging with health professionals and accessing effective and timely interventions for physical health conditions. A consequence of such struggles to navigate and access physical healthcare results in many people with SMI relying heavily on support provided by informal carers (e.g., family members, close friends). Despite this, the experiences of informal carers, and the roles they undertake in relation to supporting the physical health and psychotropic medication use of people with SMI, remains under-researched.

AIMS

To explore the impacts of providing care for physical health in severe mental illness on informal carers.

METHOD

Thematic analysis of semi-structured interviews with eight informal carers of people with SMI in United Kingdom (UK) national health services.

RESULTS

Informal carers played an active part in the management of the patient's conditions and shared their illness experience. Involvement of informal carers was both emotional and practical and informal carers' own lives were affected in ways that were sometimes deeply profound. Informal carers were involved in both 'looking after' the patient from the perspective of doing practical tasks such as collecting dispensed medication from a community pharmacy (caring for) and managing feelings and emotions (caring about).

CONCLUSIONS

Providing care for the physical health of someone with SMI can be understood as having two dimensions - 'caring for' and 'caring about'. The findings suggest a bidirectional relationship between these two dimensions, and both have a cost for the informal carer. With appropriate support informal carers could be more actively involved at all stages of care without increasing their burden. This should be with an awareness that carers may minimise the information they share about their own needs and impacts of their role to spare the person they care and themselves any distress.

The Lived Experience of Informal Caregivers of People Who Have Severe Mental Illness and Coexisting Long-Term Conditions: A Qualitative Study

BACKGROUND

People with severe mental illness (SMI) experience higher rates and poorer outcomes of physical long-term conditions (LTCs). The management of SMI and LTCs is highly complex and many people with SMI rely on informal carers for support, which may lead to high levels of caregiver burden, and caregiver burnout. Caregiver burnout can result in poor health outcomes for informal carers and a reduction in the quality of care they are able to provide. Therefore, it is important to understand the caring experience to identify and address factors that contribute to burden and burnout.

METHODS

This paper reports a secondary qualitative analysis of semistructured interviews and focus groups conducted with informal carers of people who have coexisting SMI and LTCs. We recruited 12 informal carers in England between December 2018 and April 2019. The transcripts were coded and analysed thematically.

RESULTS

We identified two overarching themes and five subthemes. The themes included 'Fighting on all fronts: Mounting strain between demands and resources', which described the challenge of providing care in the context of coexisting SMI and LTCs, and 'Safekeeping: The necessity of chronic hypervigilance', which captured how informal carers' roles were defined by managing high-risk situations, leading to hypervigilance and paternalistic approaches to care.

CONCLUSION

The experience of informal carers for people with SMI and coexisting LTCs is marked by limited access to support and the management of significant risk, which could contribute to high caregiver burden. Further primary research is needed to understand how the experiences of the caregiver role for people with SMI and LTCs influence caregiver burden.

PATIENT OR PUBLIC CONTRIBUTION

Our PPI panel DIAMONDS Voice provided guidance on this study from conception, design and development of interview guides and recruitment materials to final write-up. DIAMONDS Voice consists of service users and carers who have experience of SMI and LTCs. Three carer members reviewed the final manuscript, and two are credited as authors.

Patients with severe mental illness and their carers' expectations for GPs' communication skills: a qualitative approach in Spain

BACKGROUND

Effective communication with GPs (General Practitioners) enables higher rates of patient satisfaction and adherence to treatment plans. People with severe mental illness (SMI) and their caregivers present unique characteristics that present difficulties in the GP-carer-patient communication process.

AIM

To explore the expectations of patients with SMI and their caregivers regarding GPs' communication skills in primary care consultations.

DESIGN & SETTING

Face-to-face interviews, using focus group methodology, which were undertaken in southern Spain.

METHOD

Forty-two participants took part in 21 paired semi-structured interviews with an average duration of 19±7.2 minutes. Information was audio-recorded and transcribed verbatim. Qualitative content analysis was undertaken, obtaining a codification in categories by means of triangulation.

RESULTS

Four themes emerged from the analysis. Theme 1 was interviewer communication characteristics. The ability of GPs to use a language that was colloquial and adapted to each person was perceived as a determinant of the quality of care provided. An empathetic attitude, low reactivity, and efficient time management were the most valued communication skills. Theme 2 was telemedicine: telephone consultation and video consultation. The telephone consultation was perceived as a useful tool to care for people with SMI. Video consultation was valued as a requirement in isolated rural areas. Theme 3 was the role of the caregiver during the clinical interview. The caregiver was considered by the patients as an ally who improves the clinical interview. Theme 4 was the perceived barriers and facilitators during the clinical interview. The continuity of care, defined by a low turnover of GPs, determined the quality perceived by those who required care.

CONCLUSION

Themes emerging from this study have suggested that people with SMI require an inclusive, collaborative, and personalised approach in the care they receive from the public health system. Improved communication between GPs and patients with SMI is an essential requirement for quality medical care.

The views and perceptions of training in physical health care amongst mental health nurses, managers of mental health nurses and trainers: A systematically constructed narrative synthesis

People with serious mental illness have higher morbidity and mortality rates compared with the general population. Mental health nurses are in an optimal position to address physical healthcare needs and inequalities experienced by this group. Research evidence suggests that mental health nurses may lack appropriate skills and confidence. The training needs of mental health nurses in physical health care of patients with serious mental illness and the perceived effectiveness of training that is provided to mental health nurses are explored in this review. A narrative synthesis approach (PROSPERO protocol registration ID=CRD42021230923) involved searching five electronic databases (PsycInfo, Cinahl, Embase, Medline and Web of Science) from 1990 to 2021. Study quality was assessed, and analysis and synthesis were initially deductively guided by a theoretical framework of training effectiveness prior to inductive data analysis. Eleven studies met the inclusion criteria. For studies examining perceived effectiveness of training, four themes were derived from the theoretical framework (individual trainee characteristics, work environment, learning outcomes, transfer of training to job) and further theme (service user factor) generated inductively. For studies examining training needs, three themes were derived inductively (knowledge and skills requirements, modality of training, service and healthcare factors). The study highlights the need for ongoing learning to improve practice. It also provides another perspective in terms of understanding the influence of service user factors (motivation and mental state) in designing and implementing of future training in mental health settings.

Mental health bias in physical care: An integrative review of the literature

WHAT IS KNOWN ON THE SUBJECT?: Individuals experiencing mental illness make up a significant portion of the world's population. Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness. Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness. Educational interventions can help prepare practitioners to care for individuals with mental illness. Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. ABSTRACT: Introduction Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice Increased partnering between physical and mental health practitioners, continuing education, and improving patient-provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause.

Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses

This evolutionary concept analysis explores the meaning of diagnostic overshadowing within the context of physical health care for individuals with mental illness. Diagnostic overshadowing, the misattribution of symptoms of one illness to an already diagnosed comorbidity, leads to compromised patient care and likely contributes to increased mortality experienced by individuals with mental illness. A systematic literature search led to identification of a sample of 25 publications on the topic. Following Rodgers' Evolutionary Concept Analysis methodology, this literature sample yielded unifying definitions, shared themes, factors contributing to the action of diagnostic overshadowing, outcomes caused by this type of misdiagnosis, and possible interventions available to nurses and other healthcare providers. Understanding of the concept diagnostic overshadowing may help prevent its occurrence and its adverse results.