Can treatment burden be assessed in routine General Practice using a brief measure which is valid and reliable?

Problem

Re-designing the delivery of care to improve outcomes for people living with multiple long-term conditions (MLTC) is a global priority. One major but overlooked issue is understanding and addressing the treatment burden that people with MLTC experience. Treatment burden represents the effort that patients put into looking after their MLTC, and the impact of that workload on them. The existing measures to identify those at high risk of being overburdened are too time consuming to easily incorporate into routine clinical practice. Single-question screening measures for treatment burden have been previously explored and have had limited sensitivity and positive predictive value. This study seeks to assess the face validity of a novel short treatment burden screening questionnaire for routine clinical practice use.

Approach

Up to 15 think-aloud interviews will be conducted in March-May 2023. People with MLTC aged 18-65 years, registered in 6-8 primary care practices in/around Bristol and Greater Manchester area, will be invited. We seek to engage people from minority ethnic groups and in areas of socio-economic deprivation. Interviews will be either in-person or by telephone / video-call. Topic guide has been developed with input from the PPI group and is informed by existing literature. Participants will be asked to think aloud as they complete a short treatment burden screening questionnaire (STBQ). STBQ was developed building on previous work and patient and public involvement. The measure includes a single question to screen for high treatment burden, and an additional question allowing people to select what they find difficult from a range of options. Interview participants will be asked to comment on the layout, introduction of the question and general wording, to answer the questionnaire and discuss the reasoning behind their answers.Audio-recorded interview data will be anonymised and transcribed verbatim. Framework analysis will be conducted. Two members of the PPI group will be invited to contribute to the analysis, to ground the analysis in the lived experience of people with MLTC.

Findings

The results of the framework analysis will inform further modification of the STBQ, and will help to understand its potential usefulness in clinical practice.

Consequences

The validity of the STBQ will be explored further in an ongoing cross-sectional survey study exploring primary care factors associated with treatment burden. A short screening questionnaire for treatment burden, suitable for use in clinical practice, has the potential to enable targeted support to people identified as at risk of high treatment burden.