ABSTRACT
Objective: There is a growing interest in idiographic patient-reported outcome measures (I-PROMs) for routine outcome monitoring (ROM) and clinical feedback (CF) in psychotherapy, but to our knowledge, no systematic reviews of the empirical literature. Method: We conducted a systematic literature search for empirical papers investigating effects and experiences of I-PROMs for ROM/CF and found a total of 13 papers. There was only one experimental controlled effectiveness study. Results: We formulated a narrative summary of the data set as a whole. We conducted a secondary analysis of nine papers containing qualitative data on stakeholder experiences with I-PROMs and found three superordinate themes and eight subthemes, summarized as "I-PROMs can facilitate self-reflection for patients, assist in identifying and tracking therapeutic topics, and make patients more committed to therapy by giving them a greater sense of responsibility and empowerment. Formulating goals and problems can be difficult, and lack of progress can be demotivating. Time in therapy is precious and must be spent wisely. Effective use of I-PROMs is facilitated by flexibility and therapists' use of clinical skills." Conclusion: We discuss the limitations of the study and provide recommendations for future research and clinical practice.
ABSTRACT
ABSTRACTPurpose: Routine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming prevalent in mental health services, but there are several challenges to successful implementation. ROM/CFS seem to be helpful for some patients, but not for others. To investigate this, we explored patients' experiences with ROM/CFS as an interpersonal and psychotherapeutic process, in naturalistic settings. Method: We used video-assisted interpersonal process recall interviews to investigate the experiences of 12 patients using ROM/CFS in a Norwegian mental health outpatient clinic. Data were analyzed through systematic text condensation. Results: Our analysis resulted in three pairs of experiences with ROM/CFS: (1) Explicit vs. implicit use of information, (2) Directing focus towards or away from therapeutic topics, and (3) Giving and receiving feedback. These experiences could be helpful or hindering, depending on participants' needs and preferences. All participants needed to know that the CFS was used in a meaningful way. If not, it could be detrimental to the therapeutic process. Conclusion: In order to be helpful for patients, ROM/CFS should be used in a way that is flexible, meaningful to patients, and sensitive to individual needs and preferences. Future research should further explore this how-to aspect of ROM/CFS with different CFS and populations.
Subject(s)
Mental Health Services , Feedback , Humans , Patient Outcome Assessment , Psychotherapy , Qualitative ResearchABSTRACT
PURPOSE: Routine outcome monitoring (ROM) and clinical feedback systems (CFS) are becoming increasingly prevalent in mental health services. Their overall efficacy is unclear, but quantitative evidence suggests they can be useful tools for preventing treatment failure and enhancing therapeutic outcomes, especially for patients who are not progressing in therapy. The body of qualitative material, however, is smaller and less refined. We need to know more about how ROM/CFS is used in psychotherapy, and why it is helpful for some patients, but not others. METHODS: We recorded therapy sessions of 12 patients who were using a CFS as part of their therapies at an outpatient clinic in Norway. We then conducted video-assisted interviews and follow-up interviews with patients. Data were analyzed with systematic text condensation. RESULTS: Analysis revealed three themes: (1) triggering reflections, emotions, and self-awareness, (2) Ambivalent and ambiguous self-presentation, and (3) potential for feeling understood and talking about what matters. CONCLUSION: Answering questions in a CFS is an interpretative and intentional process of self-presentation and the results from ROM/CFS must be interpreted and explored in conversation to be clinically useful. When they are, they have potential for enhancing the therapeutic process by stimulating self-awareness, reflexivity, and allowing access to new therapeutic topics. Further research should explore this how-to aspect of ROM/CFS with different CFS and different types of patients. Integrating clinical feedback in therapeutic practice can be conceptualized as a clinical skill, which should be a part of training programs for therapists.
Subject(s)
Mental Health Services , Mental Health , Feedback , Humans , Psychotherapy , Quality of Life/psychologyABSTRACT
Routine outcome monitoring (ROM) and clinical feedback (CF) systems have become important tools for psychological therapies, but there are challenges for their successful implementation. OBJECTIVE: To overcome these challenges, a greater understanding is needed about how patients experience the use of ROM/CF. METHOD: We conducted a systematic literature search of qualitative studies on patient experiences with the use of ROM/CF in mental health services. RESULTS: The findings from 16 studies were synthesized, resulting in four meta-themes: (1) Suspicion towards service providers, (2) Flexibility and support to capture complexity, (3) Empowering patients, and (4) Developing collaborative practice. CONCLUSIONS: We discuss the implications of these meta-themes for further development and implementation of ROM/CF into clinical practice, acknowledging the limitations of our review and suggesting avenues for further research. Clinical or methodological significance of this article: This article provides useful and actionable knowledge about the patient perspective on ROM/CF, an important discussion on the current state of research in this area, and useful and concrete suggestions for further avenues of research.
