‘So just to go through the options…’: patient choice in the telephone delivery of the NHS Improving Access to Psychological Therapies services

Abstract

This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient–practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving Access to Psychological Therapies (IAPT) service. Analysis of 66 recordings of telephone‐delivered IAPT assessment sessions revealed three patterns through which choice of treatment delivery mode was presented to patients: presenting a single delivery mode; incrementally presenting alternative delivery modes, in response to patient resistance; and parallel presentation of multiple delivery mode options. We show that a distinction should be made between (i) a choice to accept or reject the offer of a single option and (ii) a choice that is a selection from a range of options. We show that the three patterns identified are ordered in terms of patient‐centredness and shared decision‐making. Our findings contribute to sociological work on healthcare interactions that has identified variability in, and variable consequences for, the ways that patients and practitioners negotiate choice and shared decision‐making. Findings are discussed in relation to tensions between the political ideology of patient choice and practical service delivery constraints.

Cognitive–behavioural versus cognitive–analytic guided self-help for mild-to-moderate anxiety: a pragmatic, randomised patient preference trial

“…Supporting personal preferences regarding what type and how treatment is delivered is enshrined in health policy. 7 However, patients complain that choice is often either not initially elicited or is subsequently ignored in routine services. 8 Additionally, when preferences are not taken into consideration during clinical trials, low participation rates can occur which then limits generalisability.…”

Telephone treatments in Improving Access to Psychological Therapies services: an analysis of use and impact on treatment uptake

“…It is important to highlight that telephone is a mode to deliver assessment and psychological treatment and patient suitability for its use should be addressed. Patient choice may increase with additional treatment modes becoming available, however, some evidence has revealed tensions between the political ideology of patient choice and practical service delivery constraints, indicating modality is usually a function of service design rather than of patient choice [32]. Patients should be offered a choice to receive assessment/treatment using different modalities and waiting times should not be different across modes.…”

Enhancing the quality of psychological interventions delivered by telephone in mental health services: increasing the likelihood of successful implementation using a theory of change

“…The assumption that face-to-face systems and processes may simply transfer to a different medium such as the telephone, has hampered service development and delivery in the past [ 37 , 38 ]. Previous research within the EQUITy research programme has highlighted the factors that are considered to prevent optimisation of psychological guided-self-help interventions delivered by telephone in primary care [ 6 , 7 , 26 – 28 ]. Drawing on this research, a service quality improvement intervention to increase patient, practitioner, and service engagement with telephone delivery was co-developed with stakeholder informants (patients, practitioners, service leads, team managers, clinical academics, and policy makers) [ 29 ].…”

“…Qualitative studies included interviews with practitioners, patients, and key informants, as well as the conversational analysis of telephone sessions delivered in IAPT services. Evidence from the qualitative studies provided an insight into the barriers and facilitators influencing delivery and engagement of patients, practitioners and services with psychological interventions delivered by telephone [ 6 , 7 , 26 – 28 ]. Following understanding of the problem, an evidence-based behaviour change intervention was co-developed with stakeholders to increase engagement and quality of telephone-delivered psychological interventions in primary care [ 29 ].…”