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‘This could be my last chance’: Therapeutic optimism in a randomised controlled trial for substance use disorders
Sociology of Health & Illness ( IF 2.7 ) Pub Date : 2021-06-12 , DOI: 10.1111/1467-9566.13297
Kaitlyn Jaffe 1, 2 , Todd Korthuis 3 , Lindsey Richardson 1, 2
Affiliation  

In randomised controlled trials (RCTs), ‘therapeutic optimism’ describes a participant's belief they will benefit from the study treatment, despite the express goal of RCTs to test unknown aspects of interventions. Harbouring such expectations may interfere with RCT participation experiences, particularly among marginalised populations, such as people with substance use disorders (PSUD) who may experience social and structural barriers to participation that also increase their vulnerability to therapeutic optimism. However, little research explores therapeutic optimism within substance use trials. Thus, we conducted a nested qualitative study within an RCT testing a treatment for alcohol and opioid use disorders in HIV clinics. Using interviews with 22 participants in Vancouver, Canada, analysis revealed themes relevant to therapeutic optimism, that were specifically linked to intrinsic (e.g. health-related) or extrinsic motivations (e.g. stipend). First, compared to extrinsically motivated participants, intrinsically motivated participants held high expectations for the trial and attributed greater agency to the study medication. Second, intrinsically motivated participants expressing therapeutic optimism anticipated marked changes in their lives from the study/medication. Finally, some participants predicted the treatment would solve substance-related issues in their communities. These findings highlight the interplay between therapeutic optimism and complex interpretations of RCT objectives among PSUD.

中文翻译:

“这可能是我最后的机会”:物质使用障碍随机对照试验中的治疗乐观

在随机对照试验 (RCT) 中,“治疗乐观主义”描述了参与者相信他们将从研究治疗中受益,尽管 RCT 的明确目标是测试干预措施的未知方面。怀有这样的期望可能会干扰 RCT 的参与体验,特别是在边缘化人群中,例如物质使用障碍 (PSUD) 的人,他们可能会遇到参与的社会和结构障碍,这也增加了他们对治疗乐观主义的脆弱性。然而,很少有研究探讨物质使用试验中的治疗乐观主义。因此,我们在一项 RCT 中进行了嵌套式定性研究,该研究测试了 HIV 诊所中酒精和阿片类药物使用障碍的治疗方法。通过对加拿大温哥华的 22 名参与者的采访,分析揭示了与治疗乐观相关的主题,与内在(例如健康相关)或外在动机(例如津贴)特别相关。首先,与外在动机的参与者相比,内在动机的参与者对试验抱有很高的期望,并将更大的作用归因于研究药物。其次,表达治疗乐观情绪的内在动机参与者预期他们的生活会因研究/药物而发生显着变化。最后,一些参与者预测这种治疗将解决他们社区中与物质相关的问题。这些发现强调了治疗乐观与 PSUD 中 RCT 目标的复杂解释之间的相互作用。有内在动机的参与者对试验抱有很高的期望,并将更大的作用归因于研究药物。其次,表达治疗乐观情绪的内在动机参与者预期他们的生活会因研究/药物而发生显着变化。最后,一些参与者预测这种治疗将解决他们社区中与物质相关的问题。这些发现强调了治疗乐观与 PSUD 中 RCT 目标的复杂解释之间的相互作用。有内在动机的参与者对试验抱有很高的期望,并将更大的作用归因于研究药物。其次,表达治疗乐观情绪的内在动机参与者预期他们的生活会因研究/药物而发生显着变化。最后,一些参与者预测这种治疗将解决他们社区中与物质相关的问题。这些发现强调了治疗乐观与 PSUD 中 RCT 目标的复杂解释之间的相互作用。一些参与者预测这种治疗将解决他们社区中与物质相关的问题。这些发现强调了治疗乐观与 PSUD 中 RCT 目标的复杂解释之间的相互作用。一些参与者预测这种治疗将解决他们社区中与物质相关的问题。这些发现强调了治疗乐观与 PSUD 中 RCT 目标的复杂解释之间的相互作用。
更新日期:2021-07-14
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