Factors influencing engagement of patients in a novel intervention for CFS/ME: a qualitative study

Aim: To establish what factors are important for patients to engage in a new intervention
for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and make
recommendations to general practitioners (GPs) on preparing a patient for referral to
such a service.
Background: NICE guidelines recommend a prominent role for primary care in the management of patients with CFS/ME, with prompt diagnosis and appropriate referral for evidence-based treatments.
Methods: A qualitative study nested within a multi-centre randomised controlled trial of two new nurse therapist delivered interventions. Semi-structured interviews carried out with 19 patients who had received pragmatic rehabilitation (PR) in the trial. Interviews were transcribed verbatim and an iterative approach used to develop themes from the data set. Findings: Factors that influence whether or not a patient engages with PR for CFS/ME are ensuring that the patient feels accepted and believed, that they accept the diagnosis, and that the model
implicated by the treatment offered to the patient matches the model of illness held by
the patient. If patients hold a clearly incompatible model of their illness, it is unlikely that they will engage with, and successfully complete, therapy. It is vital that the GP elicitsand explores such illness beliefs either before making a referral to maximise patient engagement in therapy, or that an initial session with the therapist explores attitudes to
the treatment model offered and then works with the patient’s model.