Challenges of incentivising patient centred care

Foskett-Tharby, Rachel; Hex, Nick; Chuter, Antony; Gill, Paramjit

doi:10.1136/bmj.j4532

Cited by 5 publications

(4 citation statements)

References 28 publications

(16 reference statements)

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“…[110, 111]), pay-for-performance programmes (e.g. [112, 113]), and learning health systems (where routinely collected health care data is analysed to drive continuous improvement [114])—such programmes are large-scale, address impactful clinical problems (e.g. cardiovascular mortality or antimicrobial resistance) [9, 10], and require substantial expenditure to develop and maintain (e.g.…”

Section: Discussionmentioning

confidence: 99%

Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research

et al. 2019

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Background Providing health professionals with quantitative summaries of their clinical performance when treating specific groups of patients (“feedback”) is a widely used quality improvement strategy, yet systematic reviews show it has varying success. Theory could help explain what factors influence feedback success, and guide approaches to enhance effectiveness. However, existing theories lack comprehensiveness and specificity to health care. To address this problem, we conducted the first systematic review and synthesis of qualitative evaluations of feedback interventions, using findings to develop a comprehensive new health care-specific feedback theory. Methods We searched MEDLINE, EMBASE, CINAHL, Web of Science, and Google Scholar from inception until 2016 inclusive. Data were synthesised by coding individual papers, building on pre-existing theories to formulate hypotheses, iteratively testing and improving hypotheses, assessing confidence in hypotheses using the GRADE-CERQual method, and summarising high-confidence hypotheses into a set of propositions. Results We synthesised 65 papers evaluating 73 feedback interventions from countries spanning five continents. From our synthesis we developed Clinical Performance Feedback Intervention Theory (CP-FIT), which builds on 30 pre-existing theories and has 42 high-confidence hypotheses. CP-FIT states that effective feedback works in a cycle of sequential processes; it becomes less effective if any individual process fails, thus halting progress round the cycle. Feedback’s success is influenced by several factors operating via a set of common explanatory mechanisms: the feedback method used, health professional receiving feedback, and context in which feedback takes place. CP-FIT summarises these effects in three propositions: (1) health care professionals and organisations have a finite capacity to engage with feedback, (2) these parties have strong beliefs regarding how patient care should be provided that influence their interactions with feedback, and (3) feedback that directly supports clinical behaviours is most effective. Conclusions This is the first qualitative meta-synthesis of feedback interventions, and the first comprehensive theory of feedback designed specifically for health care. Our findings contribute new knowledge about how feedback works and factors that influence its effectiveness. Internationally, practitioners, researchers, and policy-makers can use CP-FIT to design, implement, and evaluate feedback. Doing so could improve care for large numbers of patients, reduce opportunity costs, and improve returns on financial investments. Trial registration PROSPERO, CRD42015017541 Electronic supplementary material The online version of this article (10.1186/s13012-019-0883-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research

et al. 2019

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“…Such a combined therapy should adhere to guidelines for patient‐centered care, including offering an individualized treatment, continuous (verbal and nonverbal) communication, education during all aspects of treatment, working with patient‐defined goals in a treatment in which the patient is supported and empowered with a therapist having social skills, being confident, and showing specific knowledge . Applied to overweight as one of the lifestyle factors related to chronic pain, the behavioral weight reduction program should include changes in dietary and physical activity behavior weight loss program (ie, a lifestyle approach to balance caloric intake and physical activity) to comply with evidence‐based standards.…”

Section: A Multimodal Approach Addressing Lifestyle Factors Concomitamentioning

confidence: 99%

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Nijs

D’Hondt

Clarys

et al. 2019

PM&R

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Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually‐tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV.

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“…Motivational interviewing is a direct, collaborative, patient-centered communication approach for eliciting and enhancing motivation for behavior change by helping clients to resolve ambivalence and uncertainty (73,74). Motivational interviewing, as well as PNE, adheres to guidelines for patient-centered care (75), including offering individualized treatment, continuous communication (verbal and non-verbal), education during all aspects of treatment, and working with patient-defined goals in treatment where the patient is supported and empowered by a confident therapist, with social skills, giving them specific knowledge (76). A practical guide, including a script for combining motivational interviewing with PNE (72), is available and the script has been translated in multiple languages (http://www.paininmotion.be/education/tools-for-clinical-practice).…”

Section: Motivational Interviewingmentioning

confidence: 99%

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

Nijs¹,

Roose²,

Lahousse³

et al. 2021

Pain Phys

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BACKGROUND: The presence of pain decreases survival rates in cancer. Pain management in clinical settings is often suboptimal and secondary to other cancer-related treatments, leaving many people undertreated. Opioid use is associated with side effects and decreased survival rate in cancer patients. Hence, there is an urgent need for considering factors such as perceived injustice that sustain post-cancer pain and trigger a behavioral pattern associated with opioid use. Injustice beliefs represent a maladaptive pattern of cognitive appraisal that may be a salient target for improving pain-related coping in these patients. Perceived injustice is associated with increased opioid prescription and prospectively predicted opioid use at 1-year follow-up, urging the need for targeted interventions to diminish perceived injustice. OBJECTIVES: Explain the importance of screening for perceived injustice in patients with pain following cancer treatment, its potential relevance for opioid abuse, and its potential impact on the management of pain following cancer. Also, prove clinicians with a clinical guide for an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions to account for perceived injustice in patients having pain following cancer. STUDY DESIGN: A narrative review, perspective and treatment manual SETTING: Several universities, a university of applied science department, a university hospital, and a private clinic (i.e., transdisciplinary pain treatment center). METHODS: Patients were cancer survivors with pain. Intervention included modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. Measurements were taken through the Injustice Experience Questionnaire (IEQ). RESULTS: The IEQ can be used to assess perceived injustice in a valid way. Education about pain, including discussing perceived injustice, should be the first part of the management of pain in cancer survivors. In order to obtain the often-required behavioral change towards a more adaptive lifestyle, motivational interviewing can be used. To thoroughly tackle perceived injustice in patients having pain following cancer, special emphasis should be given to the individual reasons patients identify for experiencing (continued) pain and related symptoms. Pain acceptance should also be thoroughly addressed. LIMITATIONS: Clinical trials exploring the benefits, including cost-effectiveness, of such a multimodal approach in patients with pain following cancer treatment are needed. CONCLUSIONS: In light of its potential relevance for opioid abuse and potential impact on conservative management strategies, clinicians are advised to screen for perceived injustice in patients with pain following cancer treatment. Therapeutic targeting of perceived injustice can be done through an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. KEY WORDS: Anger, cancer, counselling, education, medication use, motivational interviewing, neuroscience education, opioid, perceived injustice, rehabilitation, survivor

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Challenges of incentivising patient centred care

Abstract: Professor of General Practice

Cited by 5 publications

References 28 publications

Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research

Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research

Lifestyle and Chronic Pain across the Lifespan: An Inconvenient Truth?

Pain and Opioid Use in Cancer Survivors: A Practical Guide to Account for Perceived Injustice

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