1
|
Ngamaba KH, Webber M, Xanthopoulou P, Chevalier A, Giacco D. Participation in leisure activities and quality of life of people with psychosis in England: a multi-site cross-sectional study. Ann Gen Psychiatry 2023; 22:8. [PMID: 36915120 PMCID: PMC10009983 DOI: 10.1186/s12991-023-00438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/15/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Leisure activities can improve quality of life in the general population. For people with psychosis, negative symptoms (e.g. being unmotivated, difficulty in sticking with activities) are often a barrier to engaging in social leisure activities. However, we do not know if participation in leisure activities is associated with quality of life in this group and, whether psychosocial interventions should aim to increase leisure activities. AIM This study investigates participation in social leisure activities of people with psychosis and whether their participation is associated with better quality of life. METHODS A cross-sectional survey was conducted in 6 NHS mental health trusts. Adults aged 18-65 (N = 533) with a diagnosis of a psychosis-related condition (ICD-10 F20-29) were recruited from outpatient secondary mental health services. Several measures were used including an adapted version of the Time Use Survey (TUS), the Social contacts assessment (SCA) and Manchester Short Assessment of Quality of Life (MANSA). A Structural Equation Model (SEM) was used to explore the relationships between participation in leisure activities and quality of life, and whether social contacts mediated the link. RESULTS Participants attended an average of 2.42 (SD = 1.47) leisure activities in the last 7 days. Their quality of life increased with the number of leisure activities they attended. Participation in leisure activities was positively associated with quality of life in people with psychosis (B = 0.104, SE = 0.051, p = 0.042, 95% CI [0.003 to 0.204]). Leisure activities predicted social contacts, but the link between social contacts and the quality of life was not significant. After controlling for sociodemographic factors, being female and unemployed were negatively linked with quality of life (B = - 0.101, SE = 0.048, p = 0.036, 95% CI [- 0.196 to - 0.006; B = - 0.207, SE = 0.050, p = 0.001, 95% CI [- 0.305 to - 0.108, respectively]. CONCLUSION People with psychosis who attend more leisure activities have a higher quality of life. Quality of life was lower amongst female and unemployed participants who attended leisure activities. Intervention which helps improve participation in leisure activities may be beneficial for people with psychosis. Trial registration number ISRCTN15815862.
Collapse
Affiliation(s)
- Kayonda Hubert Ngamaba
- International Centre for Mental Health Social Research (ICMHSR), School for Business and Society, University of York, Heslington, York, YO10 5DD, UK.
| | - Martin Webber
- International Centre for Mental Health Social Research (ICMHSR), School for Business and Society, University of York, Heslington, York, YO10 5DD, UK
| | - Penny Xanthopoulou
- Mental Health Research Group, College of Medicine and Health, University of Exeter, College House (1.05), St. Luke's Campus, Exeter, EX1 2LU, Devon, UK
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Newham Centre for Mental Health, Queen Mary University of London, London, E13 8SP, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Newham Centre for Mental Health, Queen Mary University of London, London, E13 8SP, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
2
|
Abstract
OBJECTIVE To review and synthesise qualitative studies that have explored subjective experiences of people with lived experience of mental health-related illness/crisis (MHC), their families and first responders. DESIGN A systematic review of qualitative evidence was conducted. English-language articles exploring the content of interactions and participants' experiences were included. DATA SOURCES MEDLINE, PsycINFO, EMBASE, CINAHL; Google Scholar, SAGE journals, Science Direct and PubMed. DATA EXTRACTION AND SYNTHESIS Two reviewers read and systematically extracted data from the included papers. Papers were appraised for methodological rigour using the Critical Appraisal Skills Programme Qualitative Checklist. Data were thematically analysed. RESULTS We identified 3483 unique records, 404 full-texts were assessed against the inclusion criteria and 79 studies were included in the qualitative synthesis. First responders (FRs) identified in studies were police and ambulance staff. Main factors influencing response are persistent stigmatised attitudes among FRs, arbitrary training and the triadic interactions between FRs, people with mental illness and third parties present at the crisis. In addition, FR personal experience of mental illness and focused training can help create a more empathetic response, however lack of resources in mental health services continues to be a barrier where 'frequent attenders' are repeatedly let down by mental health services. CONCLUSION Lack of resources in mental healthcare and rise in mental illness suggest that FR response to MHC is inevitable. Inconsistent training, complexity of procedures and persistent stigmatisation make this a very challenging task. Improving communication with family carers and colleagues could make a difference. Broader issues of legitimacy and procedural barriers should be considered in order to reduce criminalisation and ensure an empathetic response.
Collapse
Affiliation(s)
| | - Ciara Thomas
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jemima Dooley
- Mood Disorders Centre, University of Exeter, Exeter, UK
| |
Collapse
|
3
|
Tee H, Chevalier A, Webber M, Xanthopoulou P, Priebe S, Giacco D. Who wants more social contacts? A cross-sectional study of people with psychotic disorders in England. Schizophr Res 2022; 240:46-51. [PMID: 34923207 DOI: 10.1016/j.schres.2021.11.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/02/2021] [Accepted: 11/27/2021] [Indexed: 10/19/2022]
Abstract
Many people with psychosis have few social contacts which can significantly reduce quality of life. While the symptoms of psychosis are thought to contribute to social isolation, they could also lead to the perception that patients are uninterested in increasing their social contacts or in socialisation interventions. Hence, those who most need support to reduce isolation may be less likely to receive it. Despite this, studies have yet to identify the characteristics of patients who do and do not want to increase their social contacts. A cross-sectional study was conducted with 548 participants with psychosis in community mental health teams across England, covering urban and rural areas. Logistic regression analysis was used to determine predictors of wanting to vs. not wanting to increase social contacts. Content analysis was used to explore reasons. The majority (68%) of participants reported a desire for more social contacts, which was significantly associated with lower quality of life. While people with lower quality of life were more likely to express a desire for more contacts, they were less likely to feel confident in increasing them. Reasons for not wanting to increase contacts were related either to perceived barriers or to feeling content with current circumstances. It may be concluded that people with psychosis who have a lower quality of life and little confidence in socialising have a greater desire for more social contacts. Hence, contrary to traditional beliefs, they are likely to be motivated to engage with support to reduce isolation if it is offered.
Collapse
Affiliation(s)
- Helena Tee
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, Heslington, York YO10 5DD, United Kingdom
| | - Penny Xanthopoulou
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter EX2 4TH, United Kingdom
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom
| | - Domenico Giacco
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London E13 8SP, United Kingdom; East London NHS Foundation Trust, Glen Road, London E13 8SP, United Kingdom; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7HL, United Kingdom.
| |
Collapse
|
4
|
Giacco D, Kirkbride JB, Ermakova AO, Webber M, Xanthopoulou P, Priebe S. Neighbourhood characteristics and social isolation of people with psychosis: a multi-site cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1907-1915. [PMID: 34791516 PMCID: PMC9375739 DOI: 10.1007/s00127-021-02190-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE People with psychosis are vulnerable to social isolation, which is associated with worse clinical outcomes. In general populations, people living in areas with higher population density have more social contacts, while those living in more socially deprived and fragmented areas are less satisfied with their relationships. We assessed whether and how neighbourhood factors are associated with social contacts and satisfaction with friendships for people with psychosis. METHODS We carried out a cross-sectional study including people with psychosis aged 18-65 years in urban and rural sites in England. Population density and social deprivation and fragmentation indexes were described within Lower Level Super Output Areas (LSOA). Their associations with participants' social contacts and satisfaction with friendships were tested with negative binomial and ordinal regression models, respectively. RESULTS We surveyed 511 participants with psychotic disorders. They had a median of two social contacts in the previous week (interquartile range [IQR] = 1-4), and rated satisfaction with friendships as 5 out of 7 (Manchester Short Assessment of Quality of Life; IQR = 4-6). Higher population density was associated with fewer social contacts (Z-standardised relative risk [RR] = 0.88; 95% CI = 0.79-0.99, p = 0.03), but not with satisfaction with friendships (RR = 1.08; 95% CI = 0.93-1.26, p = 0.31). No associations were found for social contacts or satisfaction with friendships with social deprivation or fragmentation indexes. CONCLUSIONS Clinicians in urban areas should be aware that their patients with psychosis are more socially isolated when more people live around them, and this could impact their clinical outcomes. These findings may inform housing programmes.
Collapse
Affiliation(s)
- Domenico Giacco
- Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, England.
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England.
- Coventry and Warwickshire Partnership NHS Trust, Coventry, England.
| | - James B Kirkbride
- Division of Psychiatry, University College London, London, W1T 7BN, England
| | - Anna O Ermakova
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, Silwood Park, Buckhurst Road, Ascot, Berks, SL5 7PY, England
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, Heslington, YO10 5DD, York, UK
| | - Penny Xanthopoulou
- College of Medicine and Health, University of Exeter, St Luke's Campus, Exeter, EX2 4TH, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Service Development), Barts and the London School of Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, England
| |
Collapse
|
5
|
Giacco D, Chevalier A, Patterson M, Hamborg T, Mortimer R, Feng Y, Webber M, Xanthopoulou P, Priebe S. Effectiveness and cost-effectiveness of a structured social coaching intervention for people with psychosis (SCENE): protocol for a randomised controlled trial. BMJ Open 2021; 11:e050627. [PMID: 34903539 PMCID: PMC8671980 DOI: 10.1136/bmjopen-2021-050627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION People with psychosis tend to have smaller social networks than both people in the general population and other people with long-term health conditions. Small social networks are associated with poor quality of life. Preliminary evidence suggests that coaching patients to increase their social contacts may be effective. In this study, we assessed whether structured social coaching improves the quality of life of patients with psychosis (primary outcome) compared with an active control group, receiving information on local social activities. METHODS AND ANALYSIS A structured social coaching intervention was developed based on the literature and refined through stakeholder involvement. It draws on principles from motivational interviewing, solution focused therapy and structured information giving. It is provided over a 6-month period and can be delivered by a range of different mental health professionals. Its effectiveness and cost-effectiveness are assessed in a randomised controlled trial, compared with an active control group, in which participants are given an information booklet on local social activities. Participants are aged 18 or over, have a primary diagnosis of a psychotic disorder (International Classification of Disease: F20-29) and capacity to provide informed consent. Participants are assessed at baseline and at 6, 12 and 18 months after individual randomisation. The primary outcome is quality of life at 6 months (Manchester Short Assessment of Quality of Life). We hypothesise that the effects on quality of life are mediated by an increase in social contacts. Secondary outcomes are symptoms, social situation and time spent in social activities. Costs and cost-effectiveness analyses will consider service use and health-related quality of life. ETHICS AND DISSEMINATION National Health Service REC London Hampstead (19/LO/0088) provided a favourable opinion. Findings will be disseminated through a website, social media, scientific papers and user-friendly reports, in collaboration with a lived experience advisory panel. TRIAL REGISTRATION NUMBER ISRCTN15815862.
Collapse
Affiliation(s)
- Domenico Giacco
- Warwick Medical School, University of Warwick, Coventry, UK
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Agnes Chevalier
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Megan Patterson
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Rianna Mortimer
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Yan Feng
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Martin Webber
- Department of Social Policy and Social Work, University of York, York, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| |
Collapse
|
6
|
Abstract
Background: In the United Kingdom, suicide risk is assessed in the emergency department (ED) in a face-to-face assessment with psychiatric liaison practitioners. This study aimed to explore patient experiences of psychosocial assessment after presenting with self-harm/suicidality. Method: A total of 28 patients were interviewed within 2 weeks of ED attendance for self-harm/suicidality. Interviews were transcribed and analyzed using inductive thematic analysis. Results: People described two different experiences. A therapeutic interaction was about the "person" and made people feel their life mattered and instilled hope for the future. This was characterized by: unscripted conversation; warmth promoting disclosure; psychological exploration of feelings; validation of distress; and a coproduced care plan. A formulaic assessment was about the "risk" and made people feel their life did not matter and hopeless about the future. This was characterized by: feeling judged and not worthy of help; a focus on risk and form filling; a trivial treatment plan; and loss of trust in services. Limitations: Our study comprised a single ED and used a non-diverse sample. Conclusion: Psychosocial assessment in the ED impacts on hope for people in crisis. A focus on therapeutic communication that is about the person, as well as the risk, improves patient experience, decreases distress, and instills hope that life is worth living.
Collapse
Affiliation(s)
| | | | - Matthew Lomas
- College of Medicine and Health, University of Exeter, UK
| | - Rose McCabe
- School of Health Sciences, City University of London, UK
| |
Collapse
|
7
|
Dooley J, Booker M, Barnes R, Xanthopoulou P. Urgent care for patients with dementia: a scoping review of associated factors and stakeholder experiences. BMJ Open 2020; 10:e037673. [PMID: 32938596 PMCID: PMC7497532 DOI: 10.1136/bmjopen-2020-037673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/22/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES People with dementia are more vulnerable to complications in urgent health situations due to older age, increased comorbidity, higher dependency on others and cognitive impairment. This review explored the factors associated with urgent care use in dementia and the experiences of people with dementia, informal carers and professionals. DESIGN Scoping review. The search strategy and data synthesis were informed by people with dementia and carers. DATA SOURCES Searches of CINAHL, Embase, Medline, PsycINFO, PubMed were conducted alongside handsearches of relevant journals and the grey literature through 15 January 2019. ELIGIBILITY CRITERIA Empirical studies including all research designs, and other published literature exploring factors associated with urgent care use in prehospital and emergency room settings for people with dementia were included. Two authors independently screened studies for inclusion. DATA EXTRACTION AND SYNTHESIS Data were extracted using charting techniques and findings were synthesised according to content and themes. RESULTS Of 2967 records identified, 54 studies were included in the review. Specific factors that influenced use of urgent care included: (1) common age-related conditions occurring alongside dementia, (2) dementia as a diagnosis increasing or decreasing urgent care use, (3) informal and professional carers, (4) patient characteristics such as older age or behavioural symptoms and (5) the presence or absence of community support services. Included studies reported three crucial components of urgent care situations: (1) knowledge of the patient and dementia as a condition, (2) inadequate non-emergency health and social care support and (3) informal carer education and stress. CONCLUSIONS The scoping review highlighted a wider variety of sometimes competing factors that were associated with urgent care situations. Improved and increased community support for non-urgent situations, such as integrated care, caregiver education and dementia specialists, will both mitigate avoidable urgent care use and improve the experience of those in crisis.
Collapse
Affiliation(s)
- Jemima Dooley
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | - Matthew Booker
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, School for Social and Community Medicine, Bristol University, Bristol, UK
| | | |
Collapse
|
8
|
Dooley J, Bailey C, Xanthopoulou P, Bass N, McCabe R. Communication and understanding of mild cognitive impairment diagnoses. Int J Geriatr Psychiatry 2020; 35:662-670. [PMID: 32103532 DOI: 10.1002/gps.5284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Communication of mild cognitive impairment (MCI) diagnoses is challenging due to its heterogeneity and unclear prognosis. AIM To identify how MCI is communicated and to explore the relationship with patient and companion understanding. METHOD Conversation analysis identified whether MCI was named and explained in 43 video recorded diagnosis feedback meetings. Afterward, patients and companions were asked to name the diagnosis to assess understanding. RESULTS Mild cognitive impairment was not named in 21% meetings. Symptoms were explained as (a) a result of vascular conditions (49%), (b) a stage between normal ageing and dementia (30%), or (c) caused by psychological factors (21%). Fifty-four percentage of prognosis discussions included mention of dementia. There was no association between symptom explanations and whether prognosis discussions included dementia. Fifty-seven percentage patients and 37% companions reported not having or not knowing their diagnosis after the meeting. They were more likely to report MCI when prognosis discussions included dementia. CONCLUSIONS Doctors offer three different explanations of MCI to patients. The increased risk of dementia was not discussed in half the diagnostic feedback meetings. This is likely to reflect the heterogeneity in the definition, cause and likely prognosis of MCI presentations. Clearer and more consistent communication, particularly about the increased risk of dementia, may increase patient understanding and enable lifestyle changes to prevent some people progressing to dementia.
Collapse
Affiliation(s)
- Jemima Dooley
- Faculty of Health Sciences, Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | - Nick Bass
- Division of Psychiatry, University College London, London, UK
| | | |
Collapse
|
9
|
Tee H, Priebe S, Santos C, Xanthopoulou P, Webber M, Giacco D. Helping people with psychosis to expand their social networks: the stakeholders' views. BMC Psychiatry 2020; 20:29. [PMID: 31996175 PMCID: PMC6990576 DOI: 10.1186/s12888-020-2445-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with psychosis experience more social isolation than any other diagnostic group and have smaller social networks than the general population. This isolation can have a detrimental effect on quality of life. No direct, standardised interventions have been developed to specifically target this issue. Stakeholders input appears crucial in the process of developing such an intervention. This study aimed to identify the main considerations when developing an intervention aiming to reduce social isolation in people with psychosis. METHODS Focus groups and individual interviews were conducted with patients, carers and mental health staff. Data was thematically analysed. RESULTS Thirty four patients with psychosis, 26 carers of people experiencing psychosis and 22 mental health professionals participated in the study. Suggested aspects to be considered in a novel intervention were: i) finding and training the right staff member; ii) discussing negative social attitudes and patients' previous negative experiences, iii) addressing personal ambivalence; iv) establishing how best to provide information about social activities; v) facilitating access to social activities, vi) striking a balance between support and independence. CONCLUSION The suggestions identified can help to develop more targeted approaches to reduce social isolation within this patient group. A patient-centred approach and generic communication skills appear to be underpinning most of the helpful elements identified, whilst specific techniques and skills can help to overcome negative past experiences and motivational barriers.
Collapse
Affiliation(s)
- Helena Tee
- Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London, E13 8SP, UK. .,East London NHS Foundation Trust, Glen Road, London, E13 8SP, UK.
| | - Stefan Priebe
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London, E13 8SP UK
| | - Carlos Santos
- 0000 0004 0426 7183grid.450709.fEast London NHS Foundation Trust, Glen Road, London, E13 8SP UK
| | - Penny Xanthopoulou
- 0000 0004 1936 8024grid.8391.3College of Medicine and Health, University of Exeter. St Luke’s Campus, Exeter, EX2 4TH UK
| | - Martin Webber
- 0000 0004 1936 9668grid.5685.eDepartment of Social Policy and Social Work, University of York, Heslington, York, YO10 5DD UK
| | - Domenico Giacco
- 0000 0001 2171 1133grid.4868.2Unit for Social and Community Psychiatry, (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, Glen Road, London, E13 8SP UK ,0000 0000 8809 1613grid.7372.1Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL UK
| |
Collapse
|
10
|
Black GB, Ramsay AIG, Baim-Lance A, Eng J, Melnychuk M, Xanthopoulou P, Brown MM, Morris S, Rudd AG, Simister R, Fulop NJ. What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units. BMJ Open 2019; 9:e025367. [PMID: 31699711 PMCID: PMC6858131 DOI: 10.1136/bmjopen-2018-025367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units (HASUs). DESIGN Interview and observation study to explain patterns of variation in delivery and outcomes of care described in a quantitative partner paper (Melnychuk et al). SETTING Eight HASUs in London. PARTICIPANTS We interviewed HASU staff (n=76), including doctors, nurses, therapists and administrators. We also conducted non-participant observations of delivery of care at different times of the day and week (n=45; ~102 hours). We analysed the data for thematic content relating to the ability of staff to provide evidence-based interventions consistently at different times of the day and week. RESULTS Staff were able to deliver 'front door' interventions consistently by taking on additional responsibilities out of hours (eg, deciding eligibility for thrombolysis); creating continuities between day and night (through, eg, governance processes and staggering rotas); building trusting relationships with, eg, Radiology and Emergency Departments and staff prioritisation of 'front door' interventions. Variations by time of day resulted from reduced staffing in HASUs and elsewhere in hospitals in the evenings and at the weekend. Variations by day of week (eg, weekend effect) resulted from lack of therapy input and difficulties repatriating patients at weekends, and associated increases in pressure on Fridays and Mondays. CONCLUSIONS Evidence-based service standards can facilitate 7-day working in acute stroke services. Standards should ensure that the capacity and capabilities required for 'front door' interventions are available 24/7, while other services, for example, therapies are available every day of the week. The impact of standards is influenced by interdependencies between HASUs, other hospital services and social services.
Collapse
Affiliation(s)
- Georgia B Black
- Department of Applied Health Research, University College London, London, UK
| | - Angus I G Ramsay
- Department of Applied Health Research, University College London, London, UK
| | | | | | - Mariya Melnychuk
- Department of Applied Health Research, Imperial College London, London, UK
| | | | - Martin M Brown
- Department of Neurology, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Anthony G Rudd
- Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, UK
| | - Robert Simister
- Comprehensive Stroke Service, University College London Hospitals NHS Foundation Trust, London, UK
| | - Naomi J Fulop
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
11
|
McCabe R, Pavlickova H, Xanthopoulou P, Bass NJ, Livingston G, Dooley J. Patient and companion shared decision making and satisfaction with decisions about starting cholinesterase medication at dementia diagnosis. Age Ageing 2019; 48:711-718. [PMID: 31081513 DOI: 10.1093/ageing/afz045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND there is little research on how people with dementia are involved in treatment decisions at diagnosis. OBJECTIVE to measure shared decision making when starting cholinesterase inhibitors, investigate associations with contextual factors and explore satisfaction and experience of the diagnostic meeting. SETTING nine UK memory clinics in two geographical locations. SUBJECTS 74 people receiving dementia diagnoses (with 69 companions) and 21 doctors. METHODS we video-recorded 74 memory clinic consultations and rated doctor-shared decision making behaviours using the Observing Patient Involvement in Decision Making scale (OPTION-5 scale). Patients and companions rated their satisfaction and experience. Mixed-effects regressions investigated involvement and (i) number people present, meeting length, capacity, cognitive functioning, diagnosis; and (ii) patient/companion satisfaction and consultation experience. RESULTS mean consultation time was 26.7 min. Mean OPTION-5 score was 22.5/100 (Standard Deviation = 17.3). Doctors involved patients in decisions more often when patients had mixed dementia (β = 10.13, 95% confidence interval 1.25-19.0, P = 0.025) and in shorter meetings (β = -0.51, 95% CI -0.87 to -0.15, P = 0.006). Patient and companion satisfaction were high and not associated with whether doctors invited patient involvement. Half of patients and one-third companions were uncertain about the meeting outcome, experienced communication barriers and negative emotions. CONCLUSIONS consultations scored low on shared decision making, but were comparable to other settings and were not lower with more cognitively impaired patients. Negative patient and companion experiences reflect the importance of supporting healthcare providers to address patient and companion emotions and need for information.
Collapse
Affiliation(s)
- Rose McCabe
- School of Health Sciences, City University of London
| | | | | | | | | | | |
Collapse
|
12
|
Xanthopoulou P, McCabe R. Subjective experiences of cognitive decline and receiving a diagnosis of dementia: qualitative interviews with people recently diagnosed in memory clinics in the UK. BMJ Open 2019; 9:e026071. [PMID: 31375604 PMCID: PMC6688685 DOI: 10.1136/bmjopen-2018-026071] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 03/18/2019] [Accepted: 06/25/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore people's experiences of cognitive decline and receiving a diagnosis of dementia. DESIGN 61 semistructured interviews within 2 weeks of diagnosis. Audio recordings were transcribed, line-by-line coded using NVIVO V.11 and analysed using thematic analysis. SETTING 9 memory clinics (UK). PARTICIPANTS People with mild/moderate dementia. RESULTS Most participants were diagnosed with Alzheimer's disease (56% female, mean age 81 years). 104 codes were grouped into 22 categories, feeding into 9 subthemes and 4 overarching themes: (1) dissonance, threat to identity and visibility of dementia: dementia was associated with a progressive loss of competence, culminating in being an idiot, crazy and losing the plot. The stigma of dementia led people to hide their diagnosis from others, even close family members. However, decreasing competence in everyday tasks was becoming increasingly visible in family and wider social networks. (2) Vulnerability and being in limbo: people were frustrated by the impact of dementia on their lives and felt vulnerable. Moreover, people were disturbed by not knowing how much and when they would deteriorate further. (3) Loss of control and agency: loneliness, increasing dependence and becoming a burden foreshadowed increasing diminished personal agency. (4) Maintaining agency and self-worth: some people focused on what they could do and the benefits of diagnosis. This involved accepting the diagnosis, adapting to changes by using coping strategies and accepting support from others. This helped people to maintain personal agency and self-worth. CONCLUSION While personal acceptance of dementia is challenging, people are additionally troubled about disclosing their diagnosis to others. Limited time in diagnostic appointments and limited postdiagnostic support leave few opportunities to address the emotional impact of a dementia diagnosis. There may be opportunities for healthcare professionals to discuss with patients the benefits of staying positive, implementing coping strategies and accepting support to live well with dementia.
Collapse
Affiliation(s)
| | - Rose McCabe
- School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
13
|
McCabe R, Garside R, Backhouse A, Xanthopoulou P. Effectiveness of brief psychological interventions for suicidal presentations: a systematic review. BMC Psychiatry 2018; 18:120. [PMID: 29724203 PMCID: PMC5934886 DOI: 10.1186/s12888-018-1663-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Every year, more than 800,000 people worldwide die by suicide. The aim of this study was to conduct a systematic review of the effectiveness of brief psychological interventions in addressing suicidal thoughts and behaviour in healthcare settings. METHODS Following PRISMA guidelines, systematic searches were conducted in MEDLINE, CINAHL, EMBASE, the Cochrane Central Register of Controlled Trials and PsycINFO databases. A predefined search strategy was used. Two independent reviewers screened titles and abstracts followed by full texts against predefined inclusion criteria. Backward and forward citation tracking of included papers was conducted. Quality appraisal was conducted using the Cochrane Risk of Bias Tool for Randomized Controlled Trials and the CASP tool for randomised controlled trials. The small number and heterogeneity of studies did not allow for meta-analysis to be conducted. A narrative synthesis was conducted. RESULTS Four controlled studies of brief psychological interventions were included, conducted in Switzerland, the U.S. and across low and middle-income countries. Three studies were conducted with adults and one with adolescents. All studies were judged to be at low risk of bias. All of the interventions were implemented with patients after attending emergency departments and involved 3412 participants. The main outcomes were suicide, suicide attempts, suicidal ideation, depression and hospitalization. The components of the interventions were early therapeutic engagement, information provision, safety planning and follow-up contact for at least 12 months. The interventions drew to, different degrees, on psychological theory and techniques. Two trials that measured suicidal ideation found no impact. Two studies showed fewer suicide attempts, one showed fewer suicides and one found an effect on depression. CONCLUSIONS Although the evidence base is small, brief psychological interventions appear to be effective in reducing suicide and suicide attempts. All studies to date have been conducted with people who had attended the ED but the interventions could potentially be adopted for inpatient and other outpatient settings. Early engagement and therapeutic intervention based on psychological theories of suicidal behaviour, sustained in follow-up contacts, may be particularly beneficial. TRIAL REGISTRATION Systematic review registration: PROSPERO CRD42015025867.
Collapse
Affiliation(s)
- Rose McCabe
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK
| | - Ruth Garside
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, UK
| | - Amy Backhouse
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK
| | - Penny Xanthopoulou
- University of Exeter Medical School, Heavitree Road, Exeter, EX1 2LU, UK.
| |
Collapse
|
14
|
McCabe R, Garside R, Backhouse A, Xanthopoulou P. Effective communication in eliciting and responding to suicidal thoughts: a systematic review protocol. Syst Rev 2016; 5:31. [PMID: 26888194 PMCID: PMC4758101 DOI: 10.1186/s13643-016-0211-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the UK, over 6500 people die by suicide each year. In England alone, this is one person every 2 h. Professionals assess risk of suicide in face-to-face contacts with people potentially at risk. The National Confidential Inquiry into Suicide found that most people who took their life were classified as 'low risk' in their final contact with mental health services. Training for front-line staff in reducing suicide is a NHS priority. While there is considerable evidence on what to assess when exploring suicidal ideation, there is little evidence on how to ask sensitive questions to effectively identify suicide risk and how to respond in the treatment encounter to reduce patient distress and suicidal ideation. This is critical for identifying risk and putting appropriate care in place. METHODS An electronic search will be conducted using MEDLINE, CINAHL, Cochrane Library, EMBASE and PsycINFO databases. Controlled studies of effectiveness will be identified using a predefined search strategy. The focus will be on suicidal thoughts/feelings rather than self-harm without intent to die. Two authors will independently screen articles using predefined inclusion and exclusion criteria and relevant data will be extracted using the Cochrane Collaboration data extraction form for randomised controlled trials (RCTs). Discrepancies between the two authors will be resolved by consensus or by consulting a third author at all levels of screening. We will assess the quality of evidence as well as risk of bias. A meta-analysis will be conducted if participants, interventions and comparisons are sufficiently similar, and we will perform the meta-analysis using Stata data analysis and statistical software. DISCUSSION The results of this systematic review will be used to guide training and practice for health care professionals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015025867.
Collapse
Affiliation(s)
- Rose McCabe
- College House, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Ruth Garside
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD, UK.
| | - Amy Backhouse
- College House, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Penny Xanthopoulou
- College House, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| |
Collapse
|
15
|
Raine R, a' Bháird CN, Xanthopoulou P, Wallace I, Ardron D, Harris M, Barber J, Prentice A, Gibbs S, King M, Blazeby JM, Michie S, Lanceley A, Clarke A, Livingston G. Use of a formal consensus development technique to produce recommendations for improving the effectiveness of adult mental health multidisciplinary team meetings. BMC Psychiatry 2015; 15:143. [PMID: 26138754 PMCID: PMC4489364 DOI: 10.1186/s12888-015-0534-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/16/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multidisciplinary team (MDT) meetings are the core mechanism for delivering mental health care but it is unclear which models improve care quality. The aim of the study was to agree recommendations for improving the effectiveness of adult mental health MDT meetings, based on national guidance, research evidence and experiential insights from mental health and other medical specialties. METHODS We established an expert panel of 16 health care professionals, policy-makers and patient representatives. Five panellists had experience in a range of adult mental health services, five in heart failure services and six in cancer services. Panellists privately rated 68 potential recommendations on a scale of one to nine, and re-rated them after panel discussion using the RAND/UCLA Appropriateness Method to determine consensus. RESULTS We obtained agreement (median ≥ 7) and low variation in extent of agreement (Mean Absolute Deviation from Median of ≤1.11) for 21 recommendations. These included the explicit agreement and auditing of MDT meeting objectives, and the documentation and monitoring of treatment plan implementation. CONCLUSIONS Formal consensus development methods that involved learning across specialities led to feasible recommendations for improved MDT meeting effectiveness in a wide range of settings. Our findings may be used by adult mental health teams to reflect on their practice and facilitate improvement. In some other contexts, the recommendations will require modification. For example, in Child and Adolescent Mental Health Services, context-specific issues such as the role of carers should be taken into account. A limitation of the comparative approach adopted was that only five members of the panel of 16 experts were mental health specialists.
Collapse
Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
| | - Caoimhe Nic a' Bháird
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
| | - Penny Xanthopoulou
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
| | - Isla Wallace
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
| | - David Ardron
- Patient and Public Involvement Representative, North Trent Cancer Research Network, Consumer Research Panel, ICOSS, The University of Sheffield, Western Bank, Sheffield, S10 2TN, UK.
| | - Miriam Harris
- Patient and Public Involvement Representative, London, UK.
| | - Julie Barber
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Archie Prentice
- Royal College of Pathologists, 2 Carlton House Terrace, London, SW1Y 5AF, UK.
| | - Simon Gibbs
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0HS, UK.
- Department of Cardiology, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK.
| | - Michael King
- Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House St, London, W1W 7EH, UK.
| | - Jane M Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, Medical School Building, 74 Huntley Street, London, WC1E 6AU, UK.
| | - Alex Clarke
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG, UK.
| | - Gill Livingston
- Mental Health of Older People, Division of Psychiatry, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EH, UK.
| |
Collapse
|
16
|
Yfantopoulos J, Rouvas A, Chatzaras A, Xanthopoulou P, Theodosiadis P. Outcomes of Patients With Neovascular Age-Related Macular Degeneration (Namd) In Greece Under Ranibizumab. Value Health 2014; 17:A604. [PMID: 27202093 DOI: 10.1016/j.jval.2014.08.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- J Yfantopoulos
- National and Kapodistrian University of Athens, Athens, Greece
| | - A Rouvas
- Attikon University Hospital of Athens, Chaidari, Greece
| | - A Chatzaras
- National and Kapodistrian University of Athens, Athens, Greece
| | | | | |
Collapse
|
17
|
Raine R, Wallace I, Nic a’ Bháird C, Xanthopoulou P, Lanceley A, Clarke A, Prentice A, Ardron D, Harris M, Gibbs JSR, Ferlie E, King M, Blazeby JM, Michie S, Livingston G, Barber J. Improving the effectiveness of multidisciplinary team meetings for patients with chronic diseases: a prospective observational study. Health Services and Delivery Research 2014. [DOI: 10.3310/hsdr02370] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BackgroundMultidisciplinary team (MDT) meetings have been endorsed by the Department of Health as the core model for managing chronic diseases. However, the evidence for their effectiveness is mixed and the degree to which they have been absorbed into clinical practice varies widely across conditions and settings. We aimed to identify the key characteristics of chronic disease MDT meetings that are associated with decision implementation, a measure of effectiveness, and to derive a set of feasible modifications to MDT meetings to improve decision-making.MethodsWe undertook a mixed-methods prospective observational study of 12 MDTs in the London and North Thames area, covering cancer, heart failure, mental health and memory clinic teams. Data were collected by observation of 370 MDT meetings, completion of the Team Climate Inventory (TCI) by 161 MDT members, interviews with 53 MDT members and 20 patients, and review of 2654 patients’ medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation indicator, whether or not their preferences and other clinical/health behaviours were mentioned) and MDT features (team climate and skill mix) on the implementation of MDT treatment plans. Interview and observation data were thematically analysed and integrated to explore possible explanations for the quantitative findings, and to identify areas of diverse beliefs and practice across MDT meetings. Based on these data, we used a modified formal consensus technique involving expert stakeholders to derive a set of indications of good practice for effective MDT meetings.ResultsThe adjusted odds of implementation were reduced by 25% for each additional professional group represented [95% confidence interval (CI) 0.66 to 0.87], though there was some evidence of a differential effect by type of disease. Implementation was more likely in MDTs with clear goals and processes and a good team climate (adjusted odds of implementation increased by 7%; 95% CI 1% to 13% for a 0.1-unit increase in TCI score). Implementation varied by disease category (with the lowest adjusted odds of implementation in mental health teams) and by patient deprivation (adjusted odds of implementation for patients in the most compared with least deprived areas were 0.60, 95% CI 0.39 to 0.91). We ascertained 16 key themes within five domains where there was substantial diversity in beliefs and practices across MDT meetings. These related to the purpose, structure, processes and content of MDT meetings, as well as to the role of the patient. We identified 68 potential recommendations for improving the effectiveness of MDT meetings. Of these, 21 engendered both strong agreement (median ≥ 7) and low variation in the extent of agreement (mean absolute deviation from the median of < 1.11) among the expert consensus panel. These related to the purpose of the meetings (e.g. that agreeing treatment plans should take precedence over other objectives); meeting processes (e.g. that MDT decision implementation should be audited annually); content of the discussion (e.g. that information on comorbidities and past medical history should be routinely available); and the role of the patient (e.g. concerning the most appropriate time to discuss treatment options). Panellists from all specialties agreed that these recommendations were both desirable and feasible. We were unable to achieve consensus for 17 statements. In part, this was a result of disease-specific differences including the need to be prescriptive about MDT membership, with local flexibility deemed appropriate for heart failure and uniformity supported for cancer. In other cases, our data suggest that some processes (e.g. discussion of unrelated research topics) should be locally agreed, depending on the preferences of individual teams.ConclusionsSubstantial diversity exists in the purpose, structure, processes and content of MDT meetings. Greater multidisciplinarity is not necessarily associated with more effective decision-making and MDT decisions (as measured by decision implementation). Decisions were less likely to be implemented for patients living in more deprived areas. We identified 21 indications of good practice for improving the effectiveness of MDT meetings, which expert stakeholders from a range of chronic disease specialties agree are both desirable and feasible. These are important because MDT meetings are resource-intensive and they should deliver value to the NHS and patients. Priorities for future work include research to examine whether or not the 21 indications of good practice identified in this study will lead to better decision-making; for example, incorporating the indications into a modified MDT and experimentally evaluating its effectiveness in a pragmatic randomised controlled trial. Other areas for further research include exploring the value of multidisciplinarity in MDT meetings and the reasons for low implementation in community mental health teams. There is also scope to examine the underlying determinants of the inequalities demonstrated in this study, for example by exploring patient preferences in more depth. Finally, future work could examine the association between MDT decision implementation and improvements in patient outcomes.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Isla Wallace
- Department of Applied Health Research, University College London, London, UK
| | | | - Penny Xanthopoulou
- Department of Applied Health Research, University College London, London, UK
| | - Anne Lanceley
- University College London Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Alex Clarke
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | | | - David Ardron
- North Trent Cancer Research Network, Consumer Research Panel, South Yorkshire Comprehensive Local Research Network, Sheffield, UK
| | | | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ewan Ferlie
- Department of Management, School of Social Science and Public Policy, King’s College, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| |
Collapse
|
18
|
Raine R, Xanthopoulou P, Wallace I, Nic A' Bháird C, Lanceley A, Clarke A, Livingston G, Prentice A, Ardron D, Harris M, King M, Michie S, Blazeby JM, Austin-Parsons N, Gibbs S, Barber J. Determinants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study. BMJ Qual Saf 2014; 23:867-76. [PMID: 24915539 PMCID: PMC4173750 DOI: 10.1136/bmjqs-2014-002818] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. Methods We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the ‘Team Climate Inventory’ and skill mix) on the implementation of MDT treatment plans. Results The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good ‘Team Climate’ (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). Conclusions Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.
Collapse
Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Penny Xanthopoulou
- Department of Applied Health Research, University College London, London, UK
| | - Isla Wallace
- Department of Applied Health Research, University College London, London, UK
| | | | - Anne Lanceley
- Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Alex Clarke
- Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | | | - Dave Ardron
- North Trent Cancer Research Network, Consumer Research Panel, ICOSS, The University of Sheffield, Sheffield, UK
| | - Miriam Harris
- Patient and Public Involvement Representative, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Jane M Blazeby
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | | | - Simon Gibbs
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, UK
| | - Julie Barber
- Department of Statistical Science, University College London, London, UK
| |
Collapse
|
19
|
Raine R, Xanthopoulou P, Wallace I, Nic a’ Bháird C, Barber J, Clarke A, Lanceley A, Ardron D, Harris M, Blazeby J, Ferlie E, Gibbs S, King M, Livingston G, Michie S, Prentice A. OP92 Improving the Effectiveness of Multidisciplinary Team Meetings for Patients with Chronic Diseases: Assessing the Predictors of Decision Implementation. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
20
|
Nic a’ Bháird C, Wallace I, Xanthopoulou P, Barber J, Clarke A, Lanceley A, Ardron D, Harris M, Blazeby J, Ferlie E, Gibbs S, King M, Livingston G, Michie S, Prentice A, Raine R. PP45 Developing Recommendations to Improve the Effectiveness of Multidisciplinary Team Meetings for Patients with Chronic Diseases. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
21
|
Abstract
BACKGROUND the design and use of bed rails has been contentious since the 1950s with benefits including safety, mobility support and access to bed controls and disadvantages associated with entrapment and restraint. OBJECTIVE to explore which bed designs and patient characteristics (mobility, cognitive status and age) influence the likelihood of rails being used on UK medical wards. METHOD the use of rails was surveyed overnight at 18 hospitals between July 2010 and February 2011. RESULTS data were collected on 2,219 beds with 1,799 included (occupied). Eighty-six percent had rails attached; 52% had raised rails (42% had all raised). Adjusted logistic regression results suggest a significantly increased likelihood of rail use for (i) electric profiling beds and ultra low beds; (ii) >80 years; (iii) described as having any level of confusion or mobility impairment. These variables together explained 55% of the variance in rail use. The most frequently mentioned reason for raising rails was 'to prevent falls from the bed' (61%) especially for patients described as confused (75%). CONCLUSION there were indications that rails were being used inappropriately (as a restraint) for both confused patients and those needing assistance to mobilise.
Collapse
Affiliation(s)
- Sue Hignett
- Loughborough Design School, Loughborough University, Loughborough, Leicestershire, UK.
| | | | | | | | | | | |
Collapse
|