P051 Barriers and facilitators to eliciting and reporting of mental health symptoms in rheumatology: a mixed methods study
Notice bibliographique
Résumé
Abstract Background/Aims Mental health (MH) symptoms are common in rheumatology patients, yet greatly under-reported and therefore under-treated. Our INSPIRE project identified that >50% of patients had never/rarely reported mental health symptoms to clinicians. We undertook a follow-on study to investigate clinician and patient experiences and views regarding the eliciting and reporting of MH symptoms. Methods This study employed mixed methods. Co-designed surveys included: views and experiences of stigma, and reasons for non-reporting (patients) or non-eliciting (clinicians) of MH symptoms. Survey responses received from n = 1853 rheumatology patients and n = 400 clinicians are being analysed and compared using t tests and chi-squared tests. Qualitative analysis was thematic. Results Initial themes generated include the following: Time, prioritisation and multiplicity of symptoms: Time constraints, combined with rheumatology patients often experiencing numerous and diverse symptoms, led to clinicians and patients having to prioritise which symptoms to discuss. Joint symptoms were often prioritised, with MH/psychiatric symptoms the least discussed. For example, 85% of rheumatologists said they always/usually explicitly enquire about joint pains with SLE patients, yet for depression and hallucinations these proportions reduced to 24% and 5% respectively. Limited support for patients and clinicians: Almost all clinicians expressed a strong desire to improve understanding and support of patients’ MH needs, but identified that it also required institutional change, more education, adequate funding, improved inter-disciplinary working and a pathway for referrals: “I feel like a failure all the time in this arena. Even when we do discuss and identify a significant problem, it is very difficult to get professional help” (Ppt 76, Rheumatologist) Fear of repercussions: Patients feared clinician judgement and that future rheumatological disease symptoms would be misattributed to a primary MH condition if they reported MH symptoms. This theme also included clinicians’ fear of uncovering symptoms that they had limited experience and time to manage. One psychiatrist suggested that this has engendered a widespread “collusion of silence”. Perceived, anticipated and experienced stigma were explored. Clinicians gave significantly higher ratings (out of 5) than patients for agreeing there was stigma about MH among society (4.17 vs 3.93) and among clinicians (3.59 vs 3.29) (both p < 0.01). Normalisation and mutual trust: Facilitators of enquiring about MH symptoms included normalising neuropsychiatric symptoms and a history of a close, secure, medical relationship. The latter was typically secured by clinicians being accessible in a crisis and listening with empathy. This encouraged openness and trust, and enabled clinicians to notice changes. Conclusion This research will inform clinicians, patients and policy makers of the multiple challenges faced by both parties in the patient-clinician relationship in discussing mental health symptoms, and help address the unmet mental health needs of rheumatology patients. Disclosure M. Sloan: None. T. Pollak: None. M. Bosley: None. A. Tunks: None. W. Diment: None. M. Ubhi: None. F. Naughton: None. M. Piper: None. S. Taylor: None. C. Barrere: None. J. Brimicombe: None. J.A. Bourgeois: None. L. Andreoli: Consultancies; Consultancy fees from Eli Lilly, Glaxo Smith Kline, Janssen, Novartis, UCB, and Werfen Group. D. D’Cruz: Corporate appointments; Leadership position on the APS charity board. Consultancies; consultancy/speaker fees from GSK, Eli Lilly, Vifor and UCB.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,041 | 0,042 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,004 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».