Factors influencing engagement of patients in a novel intervention for CFS/ME (FINE?)

[oceanblue]

I'm a bit puzzled by this paper as it is about Pragmatic Rehabilitation therapy and from the FINE trial team - who, I thought, had demonstrated that this therapy didn't work.

Prim Health Care Res Dev. 2011 Apr;12(2):112-22.
Factors influencing engagement of patients in a novel intervention for CFS/ME: a qualitative study.
Chew-Graham C, Brooks J, Wearden A, Dowrick C, Peters S.

Source: School of Community-Based Medicine, University of Manchester, Manchester, UK. cchew@manchester.ac.uk

Abstract

AIM:
To establish what factors are important for patients to engage in a new intervention for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and make recommendations to general practitioners (GPs) on preparing a patient for referral to such a service.

BACKGROUND:
NICE guidelines recommend a prominent role for primary care in the management of patients with CFS/ME, with prompt diagnosis and appropriate referral for evidence-based treatments.

METHODS:
A qualitative study nested within a multi-centre randomised controlled trial of two new nurse therapist delivered interventions. Semi-structured interviews carried out with 19 patients who had received pragmatic rehabilitation (PR) in the trial. Interviews were transcribed verbatim and an iterative approach used to develop themes from the data set.

FINDINGS:
Factors that influence whether or not a patient engages with PR for CFS/ME are ensuring that the patient feels accepted and believed, that they accept the diagnosis, and that the model implicated by the treatment offered to the patient matches the model of illness held by the patient. If patients hold a clearly incompatible model of their illness, it is unlikely that they will engage with, and successfully complete, therapy. It is vital that the GP elicits and explores such illness beliefs either before making a referral to maximise patient engagement in therapy, or that an initial session with the therapist explores attitudes to the treatment model offered and then works with the patient's model.

 

[In Vitro Infidelium]

I'm a bit puzzled by this paper as it is about Pragmatic Rehabilitation therapy and from the FINE trial team - who, I thought, had demonstrated that this therapy didn't work.

Prim Health Care Res Dev. 2011 Apr;12(2):112-22.
Factors influencing engagement of patients in a novel intervention for CFS/ME: a qualitative study.
Chew-Graham C, Brooks J, Wearden A, Dowrick C, Peters S.
Source: School of Community-Based Medicine, University of Manchester, Manchester, UK. cchew@manchester.ac.uk

Translation - this study explains why our failure to demonstrate in a previous study (cost 1million) that our recommended (cough "hypothesised as valid") treatment has any value to patients, was the fault of GPs who referred patients who couldn't be persuaded that our treatment works. GPs should only send patients for treatment who are bullyable, naieve and/or unassertive.

Given that this comes from a "School of Community-Based Medicine", it bears useful comparison with the recent excellent article by Jason - who actualy identifies 'community' as something real and in which ptients are empowered not merely 'managed'.

IVI

 

[Enid]

What a waste of time and money - nothing more constructive to do ? Has common sense completely escaped some in the medical world.

 

[fla]

If a therapy is nothing more than a placebo then it follows that belief in the therapy is critical or no benefit will be obtained.

 

[biophile]

oceanblue wrote: I'm a bit puzzled by this paper as it is about Pragmatic Rehabilitation therapy and from the FINE trial team - who, I thought, had demonstrated that this therapy didn't work.

Didn't they blow over a million pounds on the FINE Trial? I noted at the time that the failure of the FINE Trial was reworded to make it appear that the problem was not enough sessions were done and the therapists involved weren't specialized enough so more research is needed. At some stage they probably also thought, "let's just milk out more papers anyway".

Chew-Graham et al wrote: Factors that influence whether or not a patient engages with PR for CFS/ME are ensuring that the patient feels accepted and believed, that they accept the diagnosis, and that the model implicated by the treatment offered to the patient matches the model of illness held by the patient. If patients hold a clearly incompatible model of their illness, it is unlikely that they will engage with, and successfully complete, therapy.

In other words, factors that influence patients' agreement is that they are in agreement. Another "No Shit Sherlock" paper?

Chew-Graham et al wrote: It is vital that the GP elicits and explores such illness beliefs either before making a referral to maximise patient engagement in therapy, or that an initial session with the therapist explores attitudes to the treatment model offered and then works with the patient's model.

In Vitro Infidelium wrote: Translation - this study explains why our failure to demonstrate in a previous study (cost 1million) that our recommended (cough "hypothesised as valid") treatment has any value to patients, was the fault of GPs who referred patients who couldn't be persuaded that our treatment works. GPs should only send patients for treatment who are bullyable, naieve and/or unassertive.

Could this have negative implications for those naughty recalcitrant patients who don't buy into Pragmatic Rehabilitation?

 

[Dolphin]

Didn't they blow over a million pounds on the FINE Trial?

Actually it was 1.3+ million in the end (initially it was going to be 1.1m).