Exploring endocrinologists’ views and experiences of psychosocial and self-management support for patients with hypothyroidism

Griffiths, Michelle

Abstract

Background
Hypothyroidism affects between 2% and 5% of the UK population. Reports suggest that up to 15% of patients report persistent symptoms despite treatment. Recommendations exist for psychosocial and self-management support for patients to address the demands of living with their condition and to develop the skills, knowledge, and experience to manage their health. In this study, Endocrinologists were asked about the provision of support for patients with hypothyroidism in secondary care. Their views, experiences, and perceptions of the barriers and facilitators to the implementation of psychosocial and self-management models of care were explored.

Methods
Eighteen Consultant Endocrinologists in the UK were recruited via a snowballing sampling technique and interviewed. Interviews were analysed using reflexive thematic analysis.

Findings
Four overarching themes were identified. In the first theme (‘Walk with them’) participants identified that patients with hypothyroidism have diverse needs for psychosocial and self-management support from the point of diagnosis, but that participants report varied will, skill and confidence to meet these needs. The second theme (‘Embedded is best’) encapsulates participants’ attempts to explore psychosocial issues and embed components of self-management support into their own practice. Difficulties in shifting the focus of the consultation towards self-management and subsequent challenges to professional identity as biomedical expert are reported. These were perceived to be confounded by debates about non-standard (T3) treatments for hypothyroidism and a lack of available support services for referral. The third theme (‘Incorporate and collaborate’) presents participants’ views that collaboration is required to address gaps in provision in primary and secondary care. Valuable partners include: Patients, Endocrine Nurses, Health Psychologists, Pharmacists, Exercise Physiologists, embedded Researchers, and experts in the charitable sector. The fourth theme (‘We can’t do this alone’) includes participant-identified barriers to progress and highlights a need for change. This includes increases in funding and research, and supportive environment which empowers clinicians to place patients at the centre of their care.

Conclusion
The findings from this research suggest that patients with hypothyroidism have unmet needs for psychosocial and self-management support from the point of diagnosis, and that Endocrinologists may to benefit from training, collaboration and support to incorporate non-medical models of care. Patients, professional collaborators, and experts in the charitable sector are valuable assets to Endocrinology and can contribute to psychosocial and self-management programmes for patients and clinician skills training, as well as acting as agents of change to address gaps in provision in primary and secondary care. A whole-systems approach is required to improve outcomes for patients with hypothyroidism and the clinicians who manage their care.

Citation

Griffiths, M. Exploring endocrinologists’ views and experiences of psychosocial and self-management support for patients with hypothyroidism. (Thesis). University of the West of England. Retrieved from https://uwe-repository.worktribe.com/output/6342608

• Thesis Type: Thesis
• Deposit Date: Jul 25, 2020
• Publicly Available Date: Oct 22, 2020
• Public URL: https://uwe-repository.worktribe.com/output/6342608
• Award Date: Oct 22, 2020