Therapists’ perceptions of barriers and facilitators to uptake and engagement with therapy in long‐term conditions - Oct 2020 Moss-Morris et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Abstract
Objective
Improving Access to Psychological Therapies (IAPT) services in England have established a long‐term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists’ perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs.

Design
A qualitative design was employed using semi‐structured interviews.

Methods
Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation.

Results
Four key themes highlighted patient, therapist, and service‐level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of ‘embedded’ versus ‘separate’ psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints.

Conclusion
Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.
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https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12475

(only mentions 'chronic fatigue' but also LTC (long term conditions) and MUS)

eta:
All authors declare no conflict of interest.
 
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You'd think the obvious answer would be to ask the patients.

I hate this sort of jargon filled pompous sounding method section, as if that means they are doing real academic research:
Methods
Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation.
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What I assume that means is they read the 15 responses and decided what were the main points being made.

It seems to boil down to not having a clue how to apply their rigid IAPT therapies with poorly trained therapists to patients with physical illnesses.

The answer is simple. Stop doing it. Admit it's useless.
 
Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.
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Which, in short, basically means: if we figure this stuff out, we'll have figured this stuff out. This could have been written verbatim a full century ago. It probably was. Multiple times. And many more times since. Because it's the whole problem: does this work? Nope, they just can't accept that. Instead they wonder how to better sell something nobody wants to buy because it's not what they need.

It's very telling that in trying to figure out how to retain patients, they ask the therapists. This supply-side approach to medicine is very, very dumb. Market solutions are not the way to fix those problems but it's very silly to have such absurd circumstances as there being a full supply of things that nobody actually wants, at least not this way. There should at least be some minimal connection between supply and demand. Reminds me of Soviets, frankly, trying to figure out what they think ordinary people need each month and producing accordingly, regardless of what's actually needed because they never actually ask or check, only work with what's possible to produce.
 
Trish said:
Y

I hate this sort of jargon filled pompous sounding method section, as if that means they are doing real academic research:
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As well as the shocking conclusion section that deems that the aggregation of a few conversations about how some providers feel has scientifically 'demonstrated the importance of' dispensing a therapy in a certain way. Normally you need a clinical trial for that; of course 'flexible, tailored' psychotherapy is not scientifically testable so we'll have to allow feelings-based medicine in this case.

I think it can be useful to talk to providers and publish honestly presented qualitative findings. It's interesting to get a feel for what they think about things. But that's all it is.
 
What does this study add? said:
Therapists are committed to working flexibly in LTCs, but feel restricted by system-level barriers.
Therapists perceive tailored online therapies as more helpful than non-specific therapies for LTCs.
Therapists perceive better engagement when patients see their care as cohesive, not separate
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This is generic mumbojumbo. It's worth even less than a pet rock.

This is an evaluation of IAPT, a giant multi-billion dollar boondoggle to the CBT-specific segment of the medical pseudoscience industry. This is how this giant muddle of wasted funding and diminishing ethics is being evaluated.

And it's even less compelling than business consultants who complete a million-dollar plus contract with a short-list that includes ping-pong tables and free pizza Fridays. Even by the usual standards of politics this is extremely corrupt and wasteful.

Usually when people try to blame science for being useless it's almost always research using fireflies, which is massively more pertinent than this mumbojumbo. But this, this is pure waste, academic self-indulgence that basically amounts to a giant taxpayer-funded circlejerk. This is research where if it were simply ended and everyone working in it terminated, literally sent home and never employed again, it would be a massive net benefit, textbook addition by subtraction.

In my freelance days I worked on my share of projects that seemed rather pointless, usually short-lived projects for a time-limited campaign. And seriously nothing I did felt as much of a complete waste as this. I don't understand how people in healthcare can so willingly be less useful than a looped video of paint drying. It baffles the mind.
 
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Sly Saint said:
https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjhp.12475

(only mentions 'chronic fatigue' but also LTC (long term conditions) and MUS)

eta:
All authors declare no conflict of interest.
Click to expand...

I'm trying to think of some of the funnier non-jobs there have been in the public or pseudo-public sector over the years, where some poor soul has had to go around doing something that never really had a purpose. I guess my closest thought is the EU common agricultural policies creating butter mountains (but at least those could theoretically 'keep'): https://en.wikipedia.org/wiki/Butter_mountain
Maybe someone was charged for a few of these things with persuading people they needed more butter in their life - surely this is the equivalent of asking said theoretical butter-sellers to save their own jobs by noting what barriers were standing in the way of end-consumers not wanting more cheap (in this case free) butter...

But then at least said people weren't also responsible for more butter being added to the already unused mountain because of this..

exactly the sort of language and research that a marketer would do - 'barriers to entry' (e.g. people not wanting to give all their personal details just to access a website). Except normally it is something that somone might find attractive and choose to access. When it is drop-off after visiting said webpage, or choosing 'no' after realising what something is or trying it out then the issue is 'wrong product for target market'. Except how do you square that circle when a different person is paying for it on the basis of it being 'good for someone else'..

Anyway, I find it hard to be convinced therefore that this is genuinely being done for the right reasons the right way (even if some of those commissioning or doing it might believe they are - lesson: those commissioning need to have better job requirements to be able to ask for measures that matter if so). Someone somewhere is being conned into thinking they want those with LTC shoved into this (and just need to be persuaded of what is good for them), but on what basis and are the facts correct or appropriate?

I guess at least this research keeps the distraction up from anyone questioning as to whether the product is useful whilst you've got them looking at this 'research' instead, and the salespitch to those funding it is 'missing the point' in its measures if you are getting them to 'look at the big aeroplane over there' of 'patients being reluctant for reasons made up by the therapists whose livelihood depends on placing the issue on patients and not whether what they are offering is any good'.
 
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