'So just to go through the options…': patient choice in the telephone delivery of the NHS Improving Access to Psychological Therapies services.

Annie Irvine,Cintia L Faija,Janice Connell,Kelly Rushton,Charlotte Welsh,Paul Drew,Judith Gellatly,Kerry Ardern,Peter Bower,Helen Brooks,Michael Barkham,Christopher J Armitage,Penny Bee

doi:10.1111/1467-9566.13182

Abstract

This article considers patient choice in mental healthcare services, specifically the ways that choice is enabled or constrained in patient-practitioner spoken interaction. Using the method of conversation analysis (CA), we examine the language used by practitioners when presenting treatment delivery options to patients entering the NHS Improving Access to Psychological Therapies (IAPT) service. Analysis of 66 recordings of telephone-delivered IAPT assessment sessions revealed three patterns through which choice of treatment delivery mode was presented to patients: presenting a single delivery mode; incrementally presenting alternative delivery modes, in response to patient resistance; and parallel presentation of multiple delivery mode options. We show that a distinction should be made between (i) a choice to accept or reject the offer of a single option and (ii) a choice that is a selection from a range of options. We show that the three patterns identified are ordered in terms of patient-centredness and shared decision-making. Our findings contribute to sociological work on healthcare interactions that has identified variability in, and variable consequences for, the ways that patients and practitioners negotiate choice and shared decision-making. Findings are discussed in relation to tensions between the political ideology of patient choice and practical service delivery constraints.

Highlights

Over the past two decades, the concept of patient choice has become enshrined in UK health policy. Greener (2009) provides an historical analysis of the use of the term ‘choice’ in UK Government publications, charting its conceptual transformation within an overarching framework of ‘health consumerism’
The rationale for creating a market in healthcare provision includes driving up quality through competition, increasing equity and positioning the patient as empowered consumer or customer (Department of Health 2004, Dixon et al 2010, Fotaki 2010), whilst choice of treatments sits within an ideology of patient involvement, empowerment and autonomy in their care
The analysis presented below draws on direct recordings of Improving Access to Psychological Therapies (IAPT) assessment sessions conducted by telephone, by Psychological Wellbeing Practitioners (PWPs) – professionals trained to assess and deliver interventions for mild-to-moderate mental health difficulties

Summary

Introduction

Over the past two decades, the concept of patient choice has become enshrined in UK health policy. Greener (2009) provides an historical analysis of the use of the term ‘choice’ in UK Government publications, charting its conceptual transformation within an overarching framework of ‘health consumerism’. For patients experiencing milder forms of depression or anxiety, IAPT services are able to offer low intensity guided self-help intervention via a range of delivery modes, including (i) group, (ii) one-to-one, (iii) telephone and (iv) digital variants of treatment (NCCMH 2019).

Results

Conclusion