Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic

TY - JOUR

T1 - Clinicians’ perspectives on supporting individuals with severe anorexia nervosa in specialist eating disorder intensive treatment settings during the COVID-19 pandemic

AU - Webb, Hannah

AU - Dalton, Bethan

AU - Irish, Madeleine

AU - Mercado, Daniela

AU - McCombie, Catherine

AU - Peachey, Gemma

AU - Arcelus, Jon

AU - Au, Katie

AU - Himmerich, Hubertus

AU - Johnston, A. Louise

AU - Lazarova, Stanimira

AU - Pathan, Tayeem

AU - Robinson, Paul

AU - Treasure, Janet

AU - Schmidt, Ulrike

AU - Lawrence, Vanessa

N1 - Funding Information: This study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (Reference: 17/123/03). Catherine McCombie was funded by an Economic and Social Research Council London Interdisciplinary Social Science Doctoral Training Partnership Studentship. Ulrike Schmidt is supported by an NIHR Senior Investigator Award and receives salary support from the NIHR Mental Health Biomedical Resource Centre at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience, King’s College London. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or the NHS. Publisher Copyright: © 2022, The Author(s).

PY - 2022/2

Y1 - 2022/2

N2 - BackgroundThe COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. However, the impact on clinicians working in these services is largely unknown. We therefore explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic.MethodsBetween May 2020 and June 2021, we interviewed clinicians (n = 21) who delivered IP and/or DP treatment to patients with severe AN in four specialist eating disorder services in the United Kingdom. Data relating to experiences during COVID-19 were analysed using reflexive thematic analysis.ResultsWe identified six themes: Disruptions to Routine Treatment; Introduction of Virtual Treatment; Separation from Treatment, Others and the World; Impact on Recovery; Impact on Staff; and Pressure on Referral Pathways. COVID-19 posed significant challenges to IP and DP services: forcing closures, operating with restrictions and virtual treatment, and impacting delivery of essential treatment components, referral pathways, clinician wellbeing, risk management, and patient isolation and recovery trajectories. Opportunities arose, in particular in DP services offering virtual support.ConclusionsCOVID-19 challenged the continuation of multidisciplinary treatment. The findings underline the necessity for medical, psychological, practical, and nutritional support, as well as carer involvement and fostering social connections to remain at the forefront of intensive treatment for severe AN. They also emphasise the uncertainty surrounding which intensive treatment may be best suited to which patient when, particularly within the context of virtual DP support.

AB - BackgroundThe COVID-19 pandemic has significantly affected intensive treatment settings (i.e., inpatient [IP] and day patient [DP]) in specialist eating disorder services. However, the impact on clinicians working in these services is largely unknown. We therefore explored the perspectives of those supporting individuals with severe anorexia nervosa (AN) in intensive treatment settings during the pandemic.MethodsBetween May 2020 and June 2021, we interviewed clinicians (n = 21) who delivered IP and/or DP treatment to patients with severe AN in four specialist eating disorder services in the United Kingdom. Data relating to experiences during COVID-19 were analysed using reflexive thematic analysis.ResultsWe identified six themes: Disruptions to Routine Treatment; Introduction of Virtual Treatment; Separation from Treatment, Others and the World; Impact on Recovery; Impact on Staff; and Pressure on Referral Pathways. COVID-19 posed significant challenges to IP and DP services: forcing closures, operating with restrictions and virtual treatment, and impacting delivery of essential treatment components, referral pathways, clinician wellbeing, risk management, and patient isolation and recovery trajectories. Opportunities arose, in particular in DP services offering virtual support.ConclusionsCOVID-19 challenged the continuation of multidisciplinary treatment. The findings underline the necessity for medical, psychological, practical, and nutritional support, as well as carer involvement and fostering social connections to remain at the forefront of intensive treatment for severe AN. They also emphasise the uncertainty surrounding which intensive treatment may be best suited to which patient when, particularly within the context of virtual DP support.

KW - Anorexia nervosa

KW - Clinicians

KW - COVID-19

KW - Day patient

KW - Eating disorders

KW - Inpatient

KW - Intensive treatment

KW - Qualitative research

KW - Telemedicine

UR - http://www.scopus.com/inward/record.url?scp=85125494445&partnerID=8YFLogxK

U2 - 10.1186/s40337-022-00555-4

DO - 10.1186/s40337-022-00555-4

M3 - Article

AN - SCOPUS:85125494445

SN - 2050-2974

VL - 10

JO - Journal of Eating Disorders

JF - Journal of Eating Disorders

IS - 1

M1 - 30

ER -