Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing

Pedley, Rebecca; McWilliams, Caitlin; Lovell, Karina; Brooks, Helen; Rushton, Kelly; Drake, Richard; Rumbold, Barnaby; Bell, Vicky; Bee, Penny

doi:10.1192/bjo.2017.5

Cited by 18 publications

(18 citation statements)

References 61 publications

(394 reference statements)

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“…Our findings identify the perceived value of sharing concerns and enhancing support in FI amongst both YP and family members, and similarly this accords with a substantial body of literature exploring family and carer experiences of family involvement in adult psychosis treatment [ 23 , 24 ]. A review of 22 qualitative studies identified the key elements of FI as therapeutic alliance, support, and the opportunity for sharing, along with the provision of psychoeducation around psychosis [14] , and each of these factors is evident in our findings.…”

Section: Discussionsupporting

confidence: 81%

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

et al. 2020

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Background There is limited evidence to inform treatment decision-making in adolescents experiencing first episode psychosis (FEP). In the MAPS trial (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with FEP received either antipsychotic medication (AP), psychological intervention (PI), or both. We investigated treatment views of young people and family members across each treatment arm of MAPS. Methods Thirteen adolescents participating in MAPS and eighteen family members attended in-depth audio-recorded interviews to discuss trial treatments. Interviews were analysed using inductive Thematic Analysis, identifying salient themes across these accounts. Findings Family members in particular reported an urgent need for treatment regardless of type. Both AP and PI were broadly viewed as acceptable treatment approaches, but for differing reasons which participants weighed against a range of concerns. AP were often seen to reduce symptoms of psychosis, though participants expressed concerns about side effects. PI were viewed as interactive treatment approaches that helped improve understanding of psychosis and enhanced coping, although some found PI emotionally and cognitively challenging. Combining treatments was seen to maximise benefits, with a perceived interaction whereby AP facilitated engagement with PI. Interpretation Acceptability of and engagement with treatments for FEP may differ between individual young people and their family/carers. In order to be able to offer fully informed choices, and determine an optimum treatment approach for young people with FEP, definitive trial evidence should be established to determine wanted and unwanted treatment impacts. Funding NIHR HTA programme (project number 15/31/04).

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Section: Discussionsupporting

confidence: 81%

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

et al. 2020

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“…Findings from qualitative adult studies are therefore needed for interpretation. In line with the present study, qualitative research has previously reported that prescribers commonly view AP as the primary or key treatment for psychosis [ 9 , 10 ]; as Shephard et al argue [10] , such views are likely to influence how information and treatment offers are presented to patients.…”

Section: Discussionsupporting

confidence: 80%

“…Clinicians’ preference for combined treatment closely accorded with family members’ views, and to a moderate degree with those of YP. Previous qualitative studies have compared views of psychosis treatment between participant groups, but focus predominantly on aspects of antipsychotic prescribing, and none discuss adolescent treatment [ 9 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…With regard to the MAPS trial, it is therefore important to understand the views of clinicians working with adolescents with psychosis as their views may influence young people's (YP) access to treatments. However, most studies exploring clinicians’ views of treatment for psychosis have consulted practitioners working with adult populations, focusing predominantly on AP prescribing [7] , [8] , [9] . For example, a recent UK qualitative study identified factors underpinning prescribing behaviour that include prescribers’ level of experience, varying levels of perceived personal responsibility for prescribing and associated risks, collaboration and compromise, patient involvement, and research evidence [10] .…”

Section: Introductionmentioning

confidence: 99%

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Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

et al. 2020

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Background Clinicians’ treatment beliefs could affect the feasibility of delivering different treatments in a randomised controlled trial (RCT). In MAPS (Managing Adolescent first Episode Psychosis: a feasibility Study), adolescents with first episode psychosis (FEP) were randomly allocated to receive either antipsychotic medication (AP), psychological intervention (cognitive behavioural therapy [CBT] and family intervention [FI]), or both. We conducted a nested qualitative study to investigate clinicians’ views of these treatments. Methods Purposive sampling identified seventeen clinicians from CAMHS and Early Intervention services with prescribing responsibilities for 14-18 year olds at three participating MAPS sites. Individual participants were interviewed to examine their views of treatments in the MAPS trial. Interview transcripts were analysed using inductive Thematic Analysis. Findings Clinicians viewed the decision to refer adolescents to the MAPS trial as requiring careful clinical judgement. Assessment complexity and diagnostic uncertainty had to be balanced against the urgency for treatment to reduce risk and distress. Underlying influences including duty of care and treatment beliefs underpinned decisions. Clinicians consistently valued AP as the primary treatment for FEP, with CBT and/or FI seen as helpful secondary treatment options. Nevertheless, the potential harms of prescribing AP, or not, to such a young population were highlighted as being of concern in treatment decision-making, and fostered reluctance to refer into a RCT. Interpretation The design and delivery of RCTs involving young people experiencing FEP should consider the views of responsible clinicians, recognising that perceived treatment urgency, limitations in diagnostic precision, and existing treatment beliefs may influence trial processes. Funding NIHR HTA programme (project number 15/31/04).

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“…Additionally, individuals experiencing severe mental health problems are often given little choice over the treatment options they receive [5][6][7][8]. Recent qualitative and survey-based studies with service users and health care staff have highlighted a number of factors that are barriers to the shared decision-making process, including perceptions regarding service user capability and capacity, aetiological beliefs, current risk to self and others, quality of research in the field, treatment costs and inadequate consultation times [9,10]. Such barriers exist despite evidence showing that shared decision-making and increased treatment choice is desired by both service users and health care staff alike [6,7,10,11] and can be beneficial for treatment-related empowerment [12] and personal recovery [13].…”

Section: Introductionmentioning

confidence: 99%

A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems

2019

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BackgroundThe development of digital health interventions (DHIs) for severe mental health problems is fast-paced. Researchers are beginning to consult service users to inform DHIs; however, much of this involvement has been limited to feedback on specific interventions post-DHI development. This study had two aims: 1. explore service user views towards DHIs for severe mental health problems; and 2. make recommendations for specific content within DHIs based on service user needs and suggestions.MethodsQualitative interviews with eighteen people with severe mental health problems focussed on two domains: 1) views about DHIs for severe mental health problems; and 2) ideas for future DHI content and design features. Data were analysed thematically.ResultsParticipants responses were captured in five key themes: 1) DHIs could be empowering tools that instigate reflection and change; 2) society is already divided; DHIs will further increase this divide; 3) considerations must be made about who has access to DHI data and how this data may be used; 4) DHIs should not be delivered without other support options; and 5) DHIs should provide a positive, fun, practical and interactive method for self-management.ConclusionsParticipants found DHIs acceptable due to the empowering nature of self-management and ability to take ownership of their own healthcare needs. However, concerns included the potential for digital exclusion, privacy and confidentiality and fears about DHIs being used to replace other mental health services. Service users want tools to help them self-manage their mental health, but also provide positive and recovery-focussed content that can be used in conjunction with other support options.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1979-1) contains supplementary material, which is available to authorized users.

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Qualitative systematic review of barriers and facilitators to patient-involved antipsychotic prescribing

Cited by 18 publications

References 61 publications

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

Understanding young peoples’ and family members’ views of treatment for first episode psychosis in a randomised controlled trial (MAPS)

Clinicians’ views of treatment types for first episode psychosis delivered in a randomised controlled trial (MAPS)

A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems

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