Clinicians\u2019 perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings

Hannah Webb,Stanimira Lazarova,Janet Treasure,Vanessa Lawrence,Madeleine Irish,Ulrike Schmidt,Tayeem Pathan,Daniela Mercado,A Louise Johnston,Catherine Mccombie,Hubertus Himmerich,Paul Robinson,Jon Arcelus,Katie Au,Bethan Dalton,Gemma Peachey

doi:10.1186/s40337-021-00528-z

Abstract

BackgroundAdmissions to intensive treatment (i.e., inpatient [IP] and/or day patient [DP]) for individuals with severe anorexia nervosa (AN) are common. Growing literature indicates potential risks and benefits of each intensive treatment approach; however, existing research has focused on patient and carer perspectives of these treatments. Also, there is scant empirical evidence available for guiding the parameters of intensive treatments for AN. We therefore explored clinicians’ perspectives and experience of supporting adults with severe AN in intensive settings.MethodsWe conducted twenty one semi-structured interviews with clinicians who deliver intensive treatments (i.e., IP and/or DP) for individuals with severe AN across four specialist Eating Disorder Services in the United Kingdom between May 2020 and June 2021. We asked clinicians about their views and experiences of supporting individuals with severe AN in intensive treatment settings and the challenges and opportunities associated with IP and DP treatment. Data were analysed using reflexive thematic analysis supported by NVivo software.ResultsFive broad and interrelated themes were identified: (1) Intensive Support; (2) The Severity of Patients’ Illnesses; (3) Hope and Recovery; (4) Which Treatment When; (5) Limited Resources; and (6) Carer Burden. We identified various similarities between the two intensive treatment approaches, including the value of intensive and multidisciplinary support and carer involvement, and the challenge of managing complex and unique needs in resource-limited intensive settings. We also found differences in the relationship of treatment to patients’ home environments, the necessity of patient motivation, and the management of risk.ConclusionsBoth intensive treatment settings are valued by clinicians; however, there are unique challenges and opportunities for supporting individuals with severe AN within each. Our findings suggest DP treatment may be used as an alternative to IP treatment for individuals with severe AN. However, clear questions remain over which intensive treatment setting is best suited to which patient when and should be the focus of future research.

Highlights

Anorexia nervosa (AN) is a complex mental disorder associated with serious physical and psychological health consequences, impaired quality of life [1, 2], and the highest standardised mortality rates of all psychiatric disorders [3]
We interviewed twenty-one clinicians working in Specialist Eating Disorder Services to explore their views on supporting people with severe anorexia nervosa in inpatient and day patient services and about the perceived advantages and disadvantages of these
Day patient treatment may be an alternative to inpatient treatment for people with severe anorexia nervosa

Summary

Introduction

Anorexia nervosa (AN) is a complex mental disorder associated with serious physical and psychological health consequences, impaired quality of life [1, 2], and the highest standardised mortality rates of all psychiatric disorders [3]. Despite well-known ethical, practical, and systemic challenges in providing intensive treatments to individuals with severe AN [9], qualitative research into clinicians’ (often referred to as healthcare professionals) perspectives and experiences of intensive treatments is limited. Exploring the views of clinicians is of relevance as there is currently a lack of empirical evidence and agreement guiding the parameters of intensive treatments for AN and it remains unclear which treatment setting works best for whom [10, 11]. The present qualitative study, aims to explore clinicians’ perspectives and experience of supporting adults with severe AN in intensive treatment settings and the opportunities and challenges associated with these. Growing literature indicates potential risks and benefits of each intensive treatment approach; existing research has focused on patient and carer perspectives of these treatments. We explored clinicians’ perspectives and experience of supporting adults with severe AN in intensive settings

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Results

Discussion

Conclusion