Acceptance of a general practitioner-led narrative exposure intervention on post-traumatic stress symptoms after intensive care: a qualitative interview study with providers.

BACKGROUND

Symptoms of post-traumatic stress disorder (PTSD) are prevalent in primary care (PC). Therapeutic needs are not always met. In the multicentred, randomised-controlled PTSD after Intensive Care Unit Survival (PICTURE) trial, patients with mild to moderate symptoms of PTSD following intensive care received a short-term intervention based on narrative exposure therapy (NET-PC) by their general practitioner (GP).

OBJECTIVE

To explore the acceptance of NET-PC by participating GPs.

DESIGN, SETTING AND

PARTICIPANTS

We conducted semi-structured telephone interviews with GPs who had performed NET-PC within the PICTURE trial. The interview guide was based on the Theoretical Framework of Acceptance. The interviews were recorded, transcribed and analysed using qualitative content analysis.

RESULTS

We analysed 15 telephone interviews averaging 51 min in length. The interviews revealed varying perceptions of the frequency and relevance of mild to moderate symptoms of PTSD. Those who saw it as relevant were ready to implement NET-PC despite its high organisational and time commitment. Challenges arose from GPs' lack of experience with psychotherapeutic interventions, including dealing with strong emotional reactions from patients, and from the difficulty of scheduling longer consultations into routine practice. Suggested support included validated screening tools, training opportunities and psychotherapeutic supervision. Furthermore, NET-PC should only be offered at the GPs' discretion.

CONCLUSIONS

From the interviewees' perspective, NET-PC is feasible for use in general practice. The identified challenges could be addressed by enhanced training and supervision and adequate funding for consultations. A NET-based intervention may be feasible in general practice for patients suffering from mild to moderate symptoms of PTSD after intensive care.

TRIAL REGISTRATION NUMBER: NCT03315390.