Injectable opioid agonist treatment (iOAT) was designed as a pragmatic and compassionate approach for people who have not benefitted from medication assisted treatment with oral opioids (e.g., methadone). While, a substantial body of clinical trial evidence has demonstrated the safety and effectiveness of iOAT, considerably less is known about the patient-centered aspects of this treatment and their role in self-reported treatment goals and outcomes. The aim of this study was to explore participants’ experiences in iOAT as they broadly relate to the domains of patient-centered care. A secondary goal was to explore how these experiences affected participants’ self-reported treatment outcomes. A qualitative methodology, and constructivist grounded theory approach, was used to guide sampling, data collection and analysis. A total of 30 in-depth interviews were conducted with people receiving iOAT in North America’s first clinic. Audio-recordings for each semi-structured interview were transcribed and read repeatedly. The strategy of constant comparison was used through iterative stages of line-by-line, focused and theoretical coding until theoretical saturation was achieved. “Building healthcare provider relationships for patient-centered care in iOAT” was the emergent core concept. Healthcare provider relationships were established through two interrelated processes: ‘Opening up’ was attributed to the positive environment, and to feeling understood and supported by healthcare providers. ‘Being a part of care’ emerged as participants felt safe to ask for what was needed and had opportunities to collaborate in treatment decisions. These processes established a foundation in which participants experienced care that was responsive to their individual dose, health and psychosocial needs. The core concept suggested that therapeutic relationships were fundamental to experiences of patient-centered care in iOAT. When relationships were respectful and understanding, participants received individualized and holistic care in iOAT. These findings offer a valuable example of how therapeutic relationships can be strengthened in other substance use treatment settings, particularly when responding to the diverse treatment needs of clients.

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Building healthcare provider relationships for patient-centered care: A qualitative study of the experiences of people receiving injectable opioid agonist treatment.

Aim: To identify indicators that diverse stakeholders believe are important when measuring recovery from addiction. Methods: Our previous work with service users had generated 28 indicators of recovery. Using Delphi group methodology (three rounds), we assessed the extent to which stakeholders working in the addictions field agreed that the 28 indicators were important on a scale of 1–10. Participants included 146 individuals with diverse job roles in 124 organisations across the British Isles. Findings: Round 1 scores were high. There was evidence of greater scoring consensus in Round 2, but this trend was less certain in Round 3. Participants scored 27/28 indicators ≥7/10 in Round 3, so confirming their importance. The only Round 3 indicator with a mean score <7 was “experiencing cravings”. There were statistical differences between the Round 3 indicator scores of some sub-groups of participants, but absolute differences were small (never more than 1 point for any indicator). Conclusions: We hav...

Emerging consensus on measuring addiction recovery: Findings from a multi-stakeholder consultation exercise

Background: Addiction recovery is receiving increasing attention in policy, practice and research. However, the concept remains vague, and it is unclear how the perspectives of important stakeholders - such as individuals in recovery and family members - relate to each other. Therefore, this study aims to capture these perspectives to provide a better understanding of what recovery entails and how optimized support can be provided. Method: To gain insight into these perspectives, 9 focus groups (6 with individuals in recovery, 3 with family members), focusing on what recovery means to the respondents, were conducted in both in- and outpatient treatment settings. The focus groups were audio-taped, transcribed and thematically analyzed. Results: Several tensions between the perspectives of individuals in recovery and family members and differences in pace emerged with regard to the 2 main categories we found in the data: (1) recovery as an act of change, and (2) the relational nature of recovery. Perspectives differ in relation to the change (existential or behavioral) that was needed for recovery, the roles of family members in recovery processes (tendency to control versus support), and the need for involvement in support. Conclusion: Differing perspectives on recovery lead to a different pace and different expectations of important stakeholders. Therefore, mutual understanding is essential to gain awareness and to better align mismatching perspectives. A supportive context can provide the needed support for both individuals in recovery and family members to go through their own recovery process, while accompanied and supported by others who proceed at their own speed.

Perspectives on addiction recovery : focus groups with individuals in recovery and family members

https://repositorio-aberto.up.pt/bitstream/10216/108683/2/229543.1.pdf

Does outcome measurement of treatment for substance use disorder reflect the personal concerns of patients? A scoping review of measures recommended in Europe.

Towards a genuinely user-centred evaluation of harm reduction and drug treatment programmes: A further proposal

Aims: The aim of this study was to investigate the views of service users (SUs), family and friends on what constitutes a good outcome for the treatment of substance misuse problems.Methods: Six focus groups were arranged to explore and identify important elements of good outcome. Transcripts of the focus groups were analysed using thematic analysis. The content of the main theme, good outcome, was cross checked with SUs and the four authors. The main theme was analysed further into sub-themes.Findings: Participants were 24 SUs and 12 family and friend members recruited from specialist drug and alcohol services. The participants represented a broad range of treatment journey experiences in a variety of treatment modalities. A total of 20 outcome elements were elicited and categorised into seven sub-themes: abstinence, health, activities, relationships, social circumstances, self-awareness and wellbeing of family and friends.Conclusions: The focus of this study was on the ideal outcome rather than intermed...

Sarah Thurgood

Papers

Service user, family and friends’ views on the meaning of a ‘good outcome’ of treatment for an addiction problem