Provider perceptions of their patients' dropout from trauma-focused therapy for PTSD in the U.S. Veterans Health Administration.
Provider perceptions of their patients' dropout from trauma-focused therapy for PTSD in the U.S. Veterans Health Administration.
复制标题
DOI：
10.1037/tra0001399
复制
发表时间：
2023-11
影响因子：
6.3
通讯作者：
Kehle-Forbes, Shannon M.
中科院分区：
文献类型：
--
作者：
Valenstein-Mah, Helen;Polusny, Melissa A.;Spoont, Michele;Ackland, Princess E.;Meis, Laura;Orazem, Robert J.;Schnurr, Paula P.;Zickmund, Susan;Chard, Kathleen;Kehle-Forbes, Shannon M.
许多开始长时间暴露(PE)和认知处理治疗(CPT)的患者并没有完成完整的疗程，尽管对提供者如何看待他们自己的患者的PE和CPT辍学知之甚少。对退伍军人健康管理局中的提供者(n=29)进行了半结构化访谈，以了解每个提供者使用PE或CPT治疗的特定患者的辍学经历。内容分析被用来将辍学的感知分类为负面的、有点负面的或非负面的。通过归纳性编码识别与某种程度上或非负面的辍学观点相关的主题。14%的提供者认为他们的患者退出PE或CPT完全是负面的，38%的人认为有点负面，48%的人认为不是负面的结果。与将辍学视为并非完全负面的因素有关的主题包括：认为如果患者还没有准备好，就不会从治疗中受益；维持治疗关系的重要性；认为以创伤为重点的治疗不是患者需要的或患者可以从其他方法中受益；认为患者已经取得了一些进展；患者有责任参与治疗并有权脱离治疗。提供者对个别患者退出PE或CPT的看法很少被视为完全负面的。需要研究来帮助提供者确定何时患者辍学是不希望的结果，以及何时需要努力让患者重新参与以创伤为重点的治疗。
Many patients who initiate prolonged exposure (PE) and cognitive processing therapy (CPT) do not complete a full course, although little is known about how providers view PE and CPT dropout among their own patients. Semistructured interviews were conducted with providers (n = 29) in the Veterans Health Administration to understand each provider’s experience of dropout by a specific patient whom they treated using PE or CPT. Content analysis was used to categorize perceptions of dropout as negative, somewhat negative, or not negative. Themes associated with somewhat or not negative views of dropout were identified via inductive coding. Fourteen percent of providers viewed their patient’s dropout from PE or CPT as wholly negative, 38% as somewhat negative, and 48% as not a negative outcome. Themes associated with viewing dropout as something other than wholly negative included belief that the patient would not benefit from treatment if they were not ready, the importance of maintaining the therapeutic relationship, the view that trauma-focused therapy was not what the patient needed or that the patient could benefit from other approaches, the impression that the patient had made some gains, and that patients are responsible for treatment engagement and have the right to disengage. Providers’ perceptions of dropout from PE or CPT for individual patients were rarely viewed as entirely negative. Research is needed to help providers determine when patient dropout is an undesirable outcome and when efforts to reengage patients in trauma-focused treatment are warranted.