Clinicians and Services Users Working Collaboratively: The ...

Clinicians and Services Users Working Collaboratively: The ...

Clinicians and Services Users Working Collaboratively: The ComQuol Study 1 A Pilot Trial to Assess the Effect of a Structure Communication Approach on the Quality of Life of Service Users in Mental Health Settings (ComQuol) 2 The research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0609-19107) The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health 3 Research Team

Professor Douglas MacInnes, Canterbury Christ Church University Dr Catherine Kinane, Kent and Medway Partnership Trust Dr Janet Parrott, Oxleas NHS Foundation Trust Professor Tom Craig, Institute of Psychiatry, Kings College, London Professor Sandra Eldridge, Queen Mary University, London Dr Ian Marsh, Canterbury Christ Church University Miss Jacqueline Mansfield, Canterbury Christ Church University Professor Stefan Priebe, Queen Mary University, London 4 Presentation Overview Five Presentations within Session 1. Background 2. The Role of a Mental Health Nurse in the ComQuol Project: Their Perspective and Involvement 3. Service User Perceptions of the ComQuol Approach: Focus Group Analysis 4. User Focused Outcomes 5. Ward and Service Focused Outcomes 5

A Pilot Trial to Assess the Effect of a Structure Communication Approach on the Quality of Life of Miss Jacqueline Mansfield, Forensic Researcher Service Users in Mental Research Assistant/Trials Manager (ComQuol) Canterbury Christ Church University Health Settings (ComQuol) Background 6 Background Department of Health (2008) defines forensic mental health care as: The provision of mental health services for people with mental

disorder who are offenders or at risk of offending. Services are provided in secure, community and criminal justice settings. 7 Background NIMHE (2004) - Lack of a service user perspective and involvement in the service and a lack of research in forensic settings concerning therapeutic relationships Paucity of published research regarding relational security in secure settings. 8 Background Walker & Gudjonsson (2000) Quality of life assessments may represent the only way of measuring the totality of detained forensic patients' experience in secure environments How is this best measured and

monitored? 9 Structured Communication Priebe et al (2002) developed intervention Approach using a structured communication approach The intervention consists of two elements: A computer-mediated approach (DIALOG+) and Non-directive counselling based on SFT Priebe et al (2007) Pan European study the intervention recorded significantly higher quality of life scores, satisfaction with treatment, and reduced unmet needs DIALOG+ has been found to be valid in rating subjective quality of life scores (Priebe et al, 2012) 10 Rationale For Our Research By focusing on improving patients QoL through their involvement in treatment

planning and delivery; building an alliance between staff and patients; developing a valid therapeutic approach Potential for producing clinical and economic benefits 11 Overview ComQuol is a pilot trial of a structured communication approach Proposed intervention comprises of six 1:1 sessions facilitated by primary nurses During each session DIALOG+ and SFT are used to elicit patients perceptions of their QoL and care It employs patient-centred approach promoting patients active participation in service provision and research 12 Hypothesis Using a structured user-clinician communication approach within a

forensic mental health setting will improve users quality of life, levels of satisfaction, engagement with services, ward atmosphere, and reduce disturbance 13 Aims and Objectives To examine the proposed methodology and establish the feasibility of the research design for a full scale trial To determine the variability of the outcomes of interest To estimate the cost of the proposed intervention To refine the intervention on the basis of study participants experiences 14 Methods Design 36-Month pragmatic cluster randomised pilot trial Six medium secure units Units stratified:

First stratum: Two units with one male ward and one female ward in each unit Second stratum: Four units with two male wards in each unit 15 Proposed Recruitment Process Six Six Medium Medium Secure Secure Units Units in in Southern Southern England England and and London London Unit Unit

liaison liaison worker worker in in each each unit unit = =6 6 Random allocation Control Control group group 3 3 units units 10 10 nurses nurses per per unit

unit = = 30 30 16 16 users users in in each each unit unit = = 48 48 Intervention Intervention group group 3 3 units units 16 16 users

users in in each each unit unit = = 48 48 10 10 nurses nurses trained trained per per unit unit = = 30 30 Methods Inclusion criteria for patients Residing on participating ward

History of 3 months of current treatment Capable of giving informed consent 17 DIALOG+ Rated on a 1 (Couldnt be worse) to 7 (Couldnt be better) Likert scale across these domains Mental health Physical health Accommodation Job situation Leisure activities Friendships Medication Personal safety Relationship with Practical help family & friends Consultations Patients view on their situation and needs are the central point of discussion; their views are explicit 18

DIALOG+ 19 Comparison Between DIALOG Sessions 20 Intervention Solution Focus Approach What difference a person wants to see in their life their preferred future What is working or going well right now Finding out strengths and resources in the person and their wider context Working out what small steps will bring about change towards that desired difference 21 Retention Flow Chart Units Assessed for Eligibility

(N = 6) Units excluded = 0 Nurses Nurses Recruited Recruited (k (k = = 92) 92) Patients Patients Approached Approached (n (n = = 182) 182) Patients Patients excluded excluded = = 70 70 Units Random (N = 6) Control

Control group group Units Units (N (N = = 3) 3) Nurses Nurses (k (k = = 45) 45) Patients Patients (n (n = = 57) 57) Intervention Intervention group group Units Units (N

(N = = 3) 3) Nurses Nurses (k (k = = 47) 47) Patients Patients (n (n = = 55) 55) Retention FlowIntervention Chart Control Control group group Units Units (N (N = = 3) 3)

Nurses Nurses (k (k = = 45) 45) Patients Patients (n (n = = 57) 57) Lost Lost to to FollowFollowFinal Up Final Up Retention Control Retention Control Group Group Numbers Numbers TP1: TP1: Nurse

Nurse (k (k = = Nurses: 3) Nurses: 3) Intervention Patients Intervention Patients = (n= = 24 24 (n= 4) 4) Control Control = = 18 18 TP2: TP2: Nurse Nurse (k (k = =

Patients: Patients: 13) 13) Intervention Intervention Patients Patients = = 47 47 (n= (n= 7) 7) Control Control = = 42 42 TP3: Nurse (k = TP3: Nurse (k = 11) 11) Patients

Patients (n= (n= 4) 4) Intervention group group Units Units (N (N = = 3) 3) Nurses Nurses (k (k = = 47) 47) Patients Patients (n (n = = Lost 55) Lost to FollowFollow55) to

Up Up Intervention Intervention Group Group TP1: TP1: Nurse Nurse (k (k = = 4) 4) Patients Patients (n= (n= 3) 3) TP2: TP2: Nurse Nurse (k (k = = 10) 10) Patients

Patients (n= (n= 2) 2) TP3: TP3: Nurse Nurse (k (k = = 9) 9) Patients Patients Patient Demographics (Baseline) Age (Mean) Gender (Total) Ethnicity (Total) Control = 57 Intervention =55

34 36 Males = 45 Females = 8 Males = 46 Females = 8 White British = 16 White Other = 4 Black = 20 Asian = 3 Mixed = 10 All Other = 0 Missing = 4 White British = 24 White Other = 10 Black = 11 Asian = 4 Mixed = 4 All Other = 1 Missing = 1

24 Patient Forensic Demographics Intervention Control = 57 (Baseline) =55 Clinical Diagnosi s (Total) Length of Current Admissi Schizophrenia = 41 Mood Disorder = 1 Personality Disorder = 8 Neurotic Disorder = 2 Behavioural Syndromes =0

Missing data = 5 Schizophrenia = 39 Mood Disorder = 2 Personality Disorder = 11 Neurotic Disorder = 0 Behavioural Syndromes =1 Missing data = 2 554 days 25 (IQR = 188, 1127) 434 days (IQR = 197, 869) Leave Statu s (Total) Ment al Healt

h Statu s Patient Forensic Demographics Control = 57 Intervention =55 (Baseline) Escorted Ground = 7 Escorted Ground = 14 Unescorted Ground = 1 Unescorted Ground = 3 Escorted Community = Escorted Community = 20 19 Unescorted Community = Unescorted Community = 5 8 No Leave = 12 No Leave = 17 Missing data = 1 Missing data = 5

Section 37 & 37/41 = 38 Section 47/49 & 48/49 = 9 Section 3 = 5 Other Section = 026 Missing data = 5 Section 37 & 37/41 = 41 Section 47/49 & 48/49 = 8 Section 3 = 3 Other Section = 1 Missing data= 1 Closing Remarks Implications Trial design viable as basis for full-scale trial Procedures functioned well Recruitment numbers Randomisation - Little differences in demographic features Training/Delivery of intervention Limitations Lost to follow up (Female patients) 27

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