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Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial

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Title: Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial
Authors: Thana, L
O'Connell, L
Carne-Watson, A
Shastri, A
Budhwani, N
Saranamuthu, A
Jayacodi, S
Leeson, V
Munjiza, J
Pappa, S
Hughes, E
Reilly, J
Crawford, M
Item Type: Journal Article
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
Issue Date: 12-Aug-2022
Date of Acceptance: 29-Jul-2022
URI: http://hdl.handle.net/10044/1/98887
DOI: 10.1186/s12888-022-04193-7
ISSN: 1471-244X
Publisher: BioMed Central
Journal / Book Title: BMC Psychiatry
Volume: 22
Copyright Statement: © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: HTA 16/95
Keywords: Science & Technology
Life Sciences & Biomedicine
Psychotic disorders
Antipsychotic medication
Sexual dysfunction
Antipsychotic medication
Psychotic disorders
Sexual dysfunction
Antipsychotic Agents
Mental Health Services
Psychotic Disorders
Referral and Consultation
State Medicine
Antipsychotic Agents
Psychotic Disorders
Mental Health Services
State Medicine
Referral and Consultation
1103 Clinical Sciences
1117 Public Health and Health Services
1701 Psychology
Publication Status: Published
Article Number: ARTN 545
Appears in Collections:Faculty of Medicine
Department of Brain Sciences

This item is licensed under a Creative Commons License Creative Commons