Adult and child and adolescent psychiatrists’ experiences of transition in anorexia nervosa : a qualitative study

Adult and child and adolescent psychiatrists’ experiences of transition in anorexia nervosa : a qualitative study

Auteurs : A. Sto­cker, L. Rosen­thal, L. Mes­qui­da, J.-P. Ray­naud, A. Revet

Réfé­rence : Jour­nal of Eating Disor­ders (10/92, 2022)

Abstract

Back­ground
Young patients suf­fe­ring from ano­rexia ner­vo­sa (AN) fre­quent­ly need fur­ther treat­ment in Adult Men­tal Health Ser­vices (AMHS). The tran­si­tion per­iod from Child and Ado­les­cent Men­tal Health Ser­vices (CAMHS) to AMHS is a cri­ti­cal time, with a high risk of disen­ga­ge­ment from heal­th­care. We explo­red phy­si­cians’ pers­pec­tives of the tran­si­tion to tri­an­gu­late the mul­tiple pers­pec­tives of phy­si­cians, parents and those with a lived AN expe­rience to more com­pre­hen­si­ve­ly cha­rac­te­rize the chal­lenges in this pro­cess of treat­ment transition.

Methods
Using pur­po­sive sam­pling, we recrui­ted 16 phy­si­cians confron­ted with tran­si­tion in AN (adult psy­chia­trists, child and ado­les­cent psy­chia­trists and pedia­tri­cian) and conduc­ted semi-struc­tu­red inter­views, which were ano­ny­mi­zed, trans­cri­bed, and ana­ly­zed fol­lo­wing the reflexive the­ma­tic ana­ly­sis framework.

Results
Our ana­ly­sis pro­du­ced three main themes. First, a sha­red agree­ment on the transition’s mal­func­tion, where par­ti­ci­pants depic­ted tran­si­tion as a dis­sa­tis­fying, violent event. Second, the concep­tion of AN as a disor­der with spe­ci­fic needs, chal­len­ging the tran­si­tion pro­cess espe­cial­ly regar­ding phy­si­cians’ enga­ge­ment. Final­ly, the ideal tran­si­tion concei­ved as a serene expe­rience of sepa­ra­tion, with una­ni­mous agree­ment on the neces­si­ty to start the tran­si­tion depen­ding on patients’ needs rather than their age, in order to turn tran­si­tions into moments of care.

Conclu­sion
Our results are in line with other qua­li­ta­tive research stu­dying tran­si­tion in AN and in other chro­nic diseases, either focu­sing on the expe­rience of heal­th­care wor­kers, fami­lies, or patients. Our research shows tran­si­tion in AN as an anxie­ty-indu­cing expe­rience for phy­si­cians, patients and fami­lies alike. Moreo­ver, we high­light a gap in the way phy­si­cians per­ceive and assist the patient’s grea­ter auto­no­my, depen­ding on their spe­cial­ty. Hel­ping phy­si­cians to manage their patient’s auto­no­my, which is a cor­ners­tone of the tran­si­tion rea­di­ness concept, could be a very effi­cient way to improve tran­si­tions in AN.

Plain English summary
Ano­rexia Ner­vo­sa (AN) is a severe disease, which most of the time starts during ado­les­cence. Tran­si­tion from Child and Ado­les­cent Men­tal Health Ser­vices to Adult Men­tal Health Ser­vices is at risk of disen­ga­ge­ment from heal­th­care. In order to bet­ter unders­tand this pro­cess, we inter­vie­wed expert phy­si­cians about their expe­riences of tran­si­tion in AN using a qua­li­ta­tive the­ma­tic ana­ly­sis which high­ligh­ted three main themes. First, a sha­red agree­ment on the transition’s mal­func­tion. Second, the concep­tion of AN as a disor­der with spe­ci­fic needs chal­len­ging the tran­si­tion pro­cess. Final­ly, the ideal tran­si­tion concei­ved as a serene expe­rience of sepa­ra­tion, which needs to be star­ted depen­ding on patients’ needs rather than their age. We also show dif­fe­rences in the way phy­si­cians per­ceive and assist the patient’s grea­ter auto­no­my acqui­red during the tran­si­tion. Hel­ping phy­si­cians to sup­port their patients in acqui­ring auto­no­my, which is a cor­ners­tone of the tran­si­tion rea­di­ness concept, could be a very effi­cient way to improve tran­si­tions in AN.