Stakeholder Coalitions and Priorities Around the Policy Goals of a Nation-Wide Mental Health Care Reform.

The difficulty of implementing mental healthcare reforms owes much to the influence of stakeholders. So far, the endorsement of mental health policy reforms by stakeholder coalitions has received little attention. This study describes stakeholder coalitions formed around common mental health policy goals and highlights their central goals and oppositions. Data were collected on the policy priorities of 469 stakeholders (policymakers, service managers, clinicians, and user representatives) involved in the Belgian mental healthcare reform. Four coalitions of stakeholders endorsing different mental health policy goals were identified using a hierarchical cluster analysis on stakeholders' policy priorities. A belief network analysis was performed to identify the central and peripheral policy goals within coalitions. Coalitions brought together stakeholders with similar professional functions. Disagreements were observed between service managers and policymakers around policy goals. The two coalitions composed of policymakers supported a comprehensive approach that combines the different goals and also supported the shortening of hospital stays, whereas the two coalitions composed of service managers emphasised the personal recovery of users and continuity of care. Regardless of the coalitions' differing policy priorities, strengthening community care was a central goal while patient-centred goals were peripheral. The competing policy positions of the coalitions identified may explain the slow and inconsistent pace of the Belgian mental healthcare reform. Strengthening community care may be an essential part of reaching consensus across coalitions. Finally, special care must be taken to ensure that patient-centred policy goals, such as social integration, are not set aside in favour of other goals.

Perspectives of hospitalized patients with mental disorders and their clinicians on vocational goals, barriers, and steps to overcome barriers.

BACKGROUND: People with mental disorders experience difficulties with finding competitive jobs. In countries with longer psychiatric hospitalization periods, the vocational rehabilitation process can start during hospitalization. Yet, rehabilitation can be hindered by a lack of focus by clinicians on the patients' vocational goals and a lack of agreement between clinicians and patients. AIMS: To compare (i) vocational goals, (ii) barriers to employment and (iii) support needed to overcome barriers faced by patients. METHOD: The paired data-set comprised 733 hospitalized patients and their 279 clinicians. Patients selected their vocational goals and clinicians indicated options that seemed realistic. Patients and clinicians indicated how many barriers exist and what support is needed to overcome barriers. RESULTS: Almost 45% of patients prefer competitive jobs, while 32% of clinicians find this realistic, indicating a moderate relationship between patients' goals and clinicians' perceptions. Patients and clinicians also differ in their perception of the level of barriers and types of support to overcome them. Patients perceive fewer vocational barriers than clinicians and prefer less intense vocational support options. CONCLUSIONS: Patients and clinicians have different perspectives concerning vocational recovery. Improving vocational rehabilitation requires a stronger alignment between patients and clinicians' vocational goals and barriers.

Using ePROMs for follow-up after palliative radiotherapy: An exploratory study with patients and health care providers.

OBJECTIVES: Patients treated with palliative radiotherapy may experience symptoms decreasing their quality of life. Electronic patient-reported outcome measures (ePROMs) could provide an opportunity to follow-up patients after treatment. METHODS: A mixed-method study was performed using self-constructed questionnaires, focus groups and interviews with patients and health care professionals (HCP). A qualitative approach was used to code the data. RESULTS: Forty-two patients, 21 radiation-oncologists, 15 general practitioners (GPs) and 24 home-care nurses completed a questionnaire. Ten patients, 6 radiation-oncologists, 14 GPs and 5 nurses were interviewed or participated in a focus group. Although patients and HCP are satisfied with current care, they believe ePROMs could improve follow-up, communication, continuity of care and self-management of symptoms. An easy to use, versatile ePROM platform seems to be important for successful implementation. Self-care tips and contact information should be added to relevant ePROM-questions, on both physical and psychological symptoms. CONCLUSION: Patients and HCP agree that ePROMs could improve systematical clinical follow-up after palliative radiotherapy, with self-management support being the primary objective of such a system. Practice implications ePROMs after palliative radiotherapy seem feasible, the exact patient population that could benefit the most will need to be explored further; as the palliative population is very diverse.