Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial
Abstract Background More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to rec...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-08-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04193-7 |
| _version_ | 1811215759126298624 |
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| author | Lavanya J. Thana Lesley O’Connell Alexandra Carne-Watson Abhishek Shastri Arunan Saravanamuthu Natasha Budhwani Sandra Jayacodi Verity C. Leeson Jasna Munjiza Sofia Pappa Elizabeth Hughes Joe Reilly Mike J. Crawford |
| author_facet | Lavanya J. Thana Lesley O’Connell Alexandra Carne-Watson Abhishek Shastri Arunan Saravanamuthu Natasha Budhwani Sandra Jayacodi Verity C. Leeson Jasna Munjiza Sofia Pappa Elizabeth Hughes Joe Reilly Mike J. Crawford |
| author_sort | Lavanya J. Thana |
| collection | DOAJ |
| description | Abstract Background More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. Methods We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. Results Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients’ mental stability, mutual discomfort and embarrassment about discussing a “taboo” subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these “hidden” side effects. Conclusion The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. Trial registration Current Controlled Trials ISRCTN12307891. |
| first_indexed | 2024-04-12T06:27:49Z |
| format | Article |
| id | doaj.art-2566b2e2e5d94e4eabe9308b6d321143 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-12T06:27:49Z |
| publishDate | 2022-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-2566b2e2e5d94e4eabe9308b6d3211432022-12-22T03:44:06ZengBMCBMC Psychiatry1471-244X2022-08-0122111210.1186/s12888-022-04193-7Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trialLavanya J. Thana0Lesley O’Connell1Alexandra Carne-Watson2Abhishek Shastri3Arunan Saravanamuthu4Natasha Budhwani5Sandra Jayacodi6Verity C. Leeson7Jasna Munjiza8Sofia Pappa9Elizabeth Hughes10Joe Reilly11Mike J. Crawford12Division of Psychiatry, Commonwealth Building, Imperial College LondonDivision of Psychiatry, Commonwealth Building, Imperial College LondonTees, Esk and Wear Valleys NHS Foundation TrustCentral and North West London NHS Foundation TrustCentral and North West London NHS Foundation TrustWest London NHS Health TrustCentral and North West London NHS Foundation TrustDivision of Psychiatry, Commonwealth Building, Imperial College LondonCentral and North West London NHS Foundation TrustWest London NHS Health TrustSchool of Health and Social Care, Edinburgh Napier UniversityTees, Esk and Wear Valleys NHS Foundation TrustDivision of Psychiatry, Commonwealth Building, Imperial College LondonAbstract Background More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. Methods We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. Results Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients’ mental stability, mutual discomfort and embarrassment about discussing a “taboo” subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these “hidden” side effects. Conclusion The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. Trial registration Current Controlled Trials ISRCTN12307891.https://doi.org/10.1186/s12888-022-04193-7Psychotic disordersAntipsychotic medicationSexual dysfunction |
| spellingShingle | Lavanya J. Thana Lesley O’Connell Alexandra Carne-Watson Abhishek Shastri Arunan Saravanamuthu Natasha Budhwani Sandra Jayacodi Verity C. Leeson Jasna Munjiza Sofia Pappa Elizabeth Hughes Joe Reilly Mike J. Crawford Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial BMC Psychiatry Psychotic disorders Antipsychotic medication Sexual dysfunction |
| title | Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial |
| title_full | Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial |
| title_fullStr | Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial |
| title_full_unstemmed | Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial |
| title_short | Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial |
| title_sort | barriers to the management of sexual dysfunction among people with psychosis analysis of qualitative data from the remedy trial |
| topic | Psychotic disorders Antipsychotic medication Sexual dysfunction |
| url | https://doi.org/10.1186/s12888-022-04193-7 |
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