Coaching to Strengthen Critical Success Factors in Integrative Care for Chronic Fatigue Patients: The Patient Needs-Resources Model 2023,Araja et al

[Sly Saint]

The final, formatted version of the article will be published soon.

Theoretical and empirical studies discover that an integrative approach is particularly important in chronic disorders and multiple long-term conditions, such as chronic fatigue. Chronic fatigue syndrome (CFS) is a classic example of a potentially severe, multisystemic illness with a wide diversity of symptoms and the corresponding diagnostic complexity. The prevalence of CFS-like syndromes expanded in the context of the COVID-19 pandemic, increasing the disorder and treatment burden. Thus, this article aimed to draw attention to the possibilities to strengthen the integrative approach to diagnosing and treating chronic disorders and multiple long-term conditions.

The main critical success factors identified for integrative approaches were: a holistic approach, that provides a more comprehensive diagnostic and personalised treatment strategy, a multidisciplinary team, and patient engagement. The strengths and weaknesses of these factors were explored and coaching was identified as a potential unifying and reinforcing element.

Coaching has a wide spectrum of manifestations clearly representing a holistic approach, that has been successfully used in multidisciplinary team building. Moreover, coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process.

Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research.

https://www.frontiersin.org/articles/10.3389/fnins.2023.1202930/abstract

 

[Trish]

Seems to be only the abstract available.

My summary - patients may benefit from someone to discuss priorities with and how to manage their activities.

Why that needs all this jargon and modelling and multidisciplinary teams I have no idea. I shudder at the idea of 'coaching'.

 

[NelliePledge]

I agree coaching could be beneficial as long as it’s not commercialised life coaching type approach. However for some people with more severe ME support from an advocate who could actively get involved in helping to sort out bureaucratic issues may be more appropriate.

be interesting to see what they mean by “active engagement in the treatment process”??

 

[Sean]

be interesting to see what they mean by “active engagement in the treatment process”??

That is the patient blaming excuse they are setting up for themselves when it doesn't work.

 

[Dolphin]

For what it is worth, the full text is now available:
https://www.frontiersin.org/articles/10.3389/fnins.2023.1202930/full

 

[Andy]

Funding for this is listed as

"The research was supported by the Horizon 2020 Project/Agreement No. 952376 “Reducing networking gaps between Riga Stradins University (RSU) and internationally leading counterparts in viral infection-induced autoimmunity research (VirA)” and Latvian Council of Science FARP Grant Number: LZP-2019/1-0380, “Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimization.”"

I fail to see how this paper could be even remotely considered to be relevant to "Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimization.".

 

[RedFox]

Funding for this is listed as

"The research was supported by the Horizon 2020 Project/Agreement No. 952376 “Reducing networking gaps between Riga Stradins University (RSU) and internationally leading counterparts in viral infection-induced autoimmunity research (VirA)” and Latvian Council of Science FARP Grant Number: LZP-2019/1-0380, “Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimization.”"

I fail to see how this paper could be even remotely considered to be relevant to "Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimization.".

Complete waste of public money. Shame on them for awarding this grant, or shame on the researchers for misusing it.

 

[Hutan]

Oh dear.

The PN-R Model might operate in such a way that, by using healthcare resources and personal resources and being aware of unmet needs, the patient actively engages in a treatment process that improves their HRQoL, which returns as enhanced personal resources. However, in real life, personal resources, which include self-efficacy, optimism, and subjective well-being, are the weakest point in ensuring patient engagement.

It doesn't seem to cross these people's minds, that patient engagement not only depends on the patient's personal resources (self-efficacy, optimism and subjective well-being), but also their assessment of the utility of the treatment.

In this context, and in light of the authors’ performed recent research on the advantages of an integrative approach in the primary healthcare of post-COVID-19 and ME/CFS patients (Araja et al., 2023), the authors suggest that coaching is important in working with chronic fatigue patients.

So, because patients are not up to the task of engaging properly, 'coaching' is required.

It's sort of ironic, isn't it, that on the one hand patients are so inadequate that they have to be dragged and coaxed to the therapy, and on the other, Paul Garner had to use his retirement hours to write reviews to actively discourage patients from undertaking a therapy. It seems to me that if patients think there is any sort of a chance of a cure, they beat a path to the clinic's door. Which suggests to me that a bit more attention to finding a therapy that actually works might be the key to success.

 

[Sean]

It doesn't seem to cross these people's minds, that patient engagement not only depends on the patient's personal resources (self-efficacy, optimism and subjective well-being), but also their assessment of the utility of the treatment.

Once again, their arbitrary starting point is projecting psycho-moral pathology upon us and denying us our agency, while pretending they are here to help us poor lost souls regain it.

 

[Midnattsol]

Oh dear.



It doesn't seem to cross these people's minds, that patient engagement not only depends on the patient's personal resources (self-efficacy, optimism and subjective well-being), but also their assessment of the utility of the treatment.


So, because patients are not up to the task of engaging properly, 'coaching' is required.

It's sort of ironic, isn't it, that on the one hand patients are so inadequate that they have to be dragged and coaxed to the therapy, and on the other, Paul Garner had to use his retirement hours to write reviews to actively discourage patients from undertaking a therapy. It seems to me that if patients think there is any sort of a chance of a cure, they beat a path to the clinic's door. Which suggests to me that a bit more attention to finding a therapy that actually works might be the key to success.

Sadly the only lecturer we had that mentioned other reasons than laziness etc. for why someone might not be compliant was ill herself.

 

[dratalanta]

... Coaching exposes support addressing the patient engagement issues identified by the Patient Needs-Resources Model (PN-R Model) such as low levels of self-efficacy, optimism, and subjective well-being. Coaching may assist patients to identify and prioritize their goals, becoming aware of their personal resources, developing strategies for managing symptoms, and building skills to increase their self-efficacy and active engagement in the treatment process. Therefore, the authors emphasize coaching as a perspective element of optimization of patient care, that requires additional theoretical and long-term empirical research...

What an incredibly cruel proposal - and I say that as a forty-year veteran of this war against nonsense.

Not content with using a biomedical grant on work that is anything but, these researchers want patients to expend their precious, precious energy attending coaching sessions where they will be told to be optimistic and to feel in control of their lives (self-efficacy).

Patients have only three responses to this: to lie to the researchers that they feel those things; to waste energy trying to explain reality to the researchers; and to attempt to believe what for many patients are simply statistical falsehoods (that they are likely to get better and are in control of achieving their goals), with the inevitable result of self-blame and disappointment.

This is a prescription for medically-induced psychological trauma.

 

[Sean]

This is a prescription for medically-induced psychological trauma.

Yep. It is highly abusive. They are forcing patients into an extremely nasty and dangerous double-bind.

Over a century of psych, and this is all they have to 'offer'.

 

[bobbler]

Seems to be only the abstract available.

My summary - patients may benefit from someone to discuss priorities with and how to manage their activities.

Why that needs all this jargon and modelling and multidisciplinary teams I have no idea. I shudder at the idea of 'coaching'.

And the use of the phrase ‘optimism’ which has been used so toxically by many to close down those who are trying to describe a factual reality they want to delude by ‘reframing’

I think it has reminded me seeing this word how important it is that somehow we are able to take back ownership of both the paradigm of what the illness is (fixed amounts of energy), how someone can manage their life within this (heeding that and planning and prioritising) and how respect should be due from others of what people manage to do and how they are despite the limitations that imposed - WITHOUT that turning into rounds of applause and back pats for pushing limits. Most who work in these coaching areas don’t get that. I didn’t even get it when I was less severe because I was bathed in a culture that is so manipulative (lots of norms use others and use techniques ‘like’ CBT to encourage others to do as works for them - which is often them implicitly telling themselves find that they are ‘worse off’ and ‘more busy’ via head pats) so I’d also say ‘recovered’ pwme in particular and be cautious of cocky other patients too.

optimism technically doesn’t need to involve being a fantasist on recovery and lies about hope but it really has become bas****used to become a vile term used to judge and get one over on others by people pretending they are ‘nice’ (to clarify I mean not being bad because that’s another thing there are lots who are unkind whilst shrouding it in ‘niceities’ to pretend to themselves they aren’t being unkind).

clarity and stopping the deliberate ambiguity in order to shapeshift and allow people to kid themselves abuse can be help if you just call it help instead is much needed in relation to our illness

 

[bobbler]

I agree coaching could be beneficial as long as it’s not commercialised life coaching type approach. However for some people with more severe ME support from an advocate who could actively get involved in helping to sort out bureaucratic issues may be more appropriate.

be interesting to see what they mean by “active engagement in the treatment process”??

Indeed if everyone at the start of their diagnosis or any point of change health or situation-wise had someone to speak for them (because it isn’t just health that makes it impossible even to tell someone you know who might do it for you but the enormity of the task)

- but plus a third party has to/has more chance of being believed or heeded than if person says it themselves. Sadly I think a lot of that would be helped by the idea said advocate will come back and have another word if they are ignored - because a lot of people do what they want unless they think they will be caught out or pulled up.

so much disability in pwme is purely due to this absence of our being looked after - and others being primed to do the opposites and harming us due to BPSm. I can see why they never audited and registered severity because I think the impact of not having this and the wrong paradigm for management had creating so many fold more disability than was ever necessary it’s an outrage when you think of it. How many would be mild and managing life instead of bedbound for so many years if things were different vs the percentages who got worsened this way we have now?

 

[bobbler]

What an incredibly cruel proposal - and I say that as a forty-year veteran of this war against nonsense.

Not content with using a biomedical grant on work that is anything but, these researchers want patients to expend their precious, precious energy attending coaching sessions where they will be told to be optimistic and to feel in control of their lives (self-efficacy).

Patients have only three responses to this: to lie to the researchers that they feel those things; to waste energy trying to explain reality to the researchers; and to attempt to believe what for many patients are simply statistical falsehoods (that they are likely to get better and are in control of achieving their goals), with the inevitable result of self-blame and disappointment.

This is a prescription for medically-induced psychological trauma.

Well encapsulated

I’m glad the coercion that this ‘school’ is basically selling as a methodology and treatment has been well described and elucidated - you’d hope even these deluded authors could understand it in those terms.

my next point is an issue where people are too forgiving of themselves who do these things. They forget the stage where they need to admit what they’ve done, face the damage they cause, apologise and then heal by being better and not doing it again. Those who don’t shouldn’t forgive themselves. It frustrates me they think they are entitled to it as long as they delude themselves or focus on their ‘action’ as an ‘oops anyone could have done it’ instead of being willing to hear the seriousness of what they caused.