“If It Wasn’t for Him, I Wouldn’t Have Talked to Them”: Qualitative Study of Addiction Peer Mentorship in the Hospital

Abstract

BACKGROUND: Hospitalizations related to substance use disorders (SUD) are skyrocketing. Hospital providers commonly feel unprepared to care for patients with SUD and patients with SUD commonly feel discriminated against by hospital staff. This tension can lead to provider burnout and poor patient outcomes. Research in ambulatory settings suggests that peer mentors (PMs) can improve substance use outcomes and patient experience. However, no study has examined the role of peer mentorship for patients with SUD in hospitals. OBJECTIVE: Understand how peer mentorship affects care for hospitalized patients with SUD, and how working in a hospital affects PMs' sense of professional identity. DESIGN: Qualitative study utilizing participant observation, individual interviews, and focus groups related to the PM component of the Improving Addiction Care Team (IMPACT), a hospital-based interprofessional addiction medicine consult service. PARTICIPANTS: IMPACT providers, patients seen by IMPACT , PMs, and a PM supervisor. APPROACH: Qualitative thematic analysis. KEY RESULTS: PMs occupy a unique space in the hospital and are able to form meaningful relationships with hospitalized patients based on trust and shared lived experiences. PMs facilitate patient care by contextualizing patient experiences to teams and providers. Reciprocally, PMs "translate" provider recommendations to patients in ways that patients can hear. Respondents described PMs as "cultural brokers" who have the potential to transfer trust that they have earned with patients to providers and systems who may otherwise be viewed as untrustworthy. While PMs felt their role led to professional and personal development, the intensity of the role in the hospital setting also put them at risk for emotional drain and stress. CONCLUSIONS: While integrating PMs into hospital care presents substantial challenges, PMs may act as a "secret weapon" to engage often marginalized hospitalized patients with SUD and improve patient and provider experience.

Peer Support Workers as a Bridge: A Qualitative Study Exploring the Role of Peer Support Workers in the Care of People Who Use Drugs During and After Hospitalization 

“…Our study supports the analogy of peer support workers serving a bridge. This is consistent with the limited studies available on peer workers in hospitals [8,11]. As a bridge, peer workers can ease transitions in care between hospital and community, and can facilitate stronger therapeutic alliances between PWUD and their healthcare teams.…”

“…HCPs felt peer workers could assist them in building a stronger therapeutic alliance with PWUD by facilitating communication and identifying areas of clinical care that could be triggering or distressing to PWUD. This is aligned with existing literature highlighting peer workers' ability to reframe and contextualize the patient experience to enhance HCPs' understanding [8]. Given the abundance of literature describing the historically challenging relationships between HCPs and PWUD, the potential for peer workers to assist in bridging this divide was a positive nding.…”

“…To our knowledge, two studies have been published that speci cally examine the role of peer workers for PWUD while in hospital [8,11]. Both studies arose from the integration of "peer mentors" into an inpatient addiction consultation team (IMPACT) in Portland, Oregon [8,11].…”

“…To our knowledge, two studies have been published that speci cally examine the role of peer workers for PWUD while in hospital [8,11]. Both studies arose from the integration of "peer mentors" into an inpatient addiction consultation team (IMPACT) in Portland, Oregon [8,11]. One study highlighted strategies to successfully integrate peer mentors into the healthcare team and identi ed that clear role de nition, structured hiring and retention process, and ongoing training were critical [11].…”

“…One study highlighted strategies to successfully integrate peer mentors into the healthcare team and identi ed that clear role de nition, structured hiring and retention process, and ongoing training were critical [11]. The second study evaluated the role of peer mentors and found that they were considered valuable additions to the healthcare team, assisted in engaging patients, and acted as cultural brokers between patients and HCPs [8].…”