Participation in the taper support interventions
depressive, SPD, somatic comorbidity, pain
RECRUITMENT
The current study adopted a comprehensive approach to implementing taper support in primary care. This included an inclusive recruitment strategy in a relatively large number of GP practices, offering a decision aid to discuss advantages and disadvantages of tapering, materials to devise a gradual and patient-tailored tapering schedule, plus additional support from a mental health nurse (i.e. SPD) and a patient-tailored MBCT intervention. Thus, in theory, our approach seemed adequate to reach and support professionals and patients who may have experienced a lack of support in regular healthcare. Nevertheless, despite the perceived need for such support, actual participation in patient-tailored interventions was low, both at the level of the GP practices (only a quarter of the invited practices participated), and at the level of patients of whom only about one tenth responded to the study invitation. This is in line with previous studies that aimed to support tapering in long-term users [Of those who did respond to the invitation, less than half participated in the intervention study. Patients’ reasons for non-discontinuation included fear of recurring symptoms, pain, somatic comorbidity, social circumstances, or clinicians’ advice against tapering. Only a minority of the patients actually reported using the decision aid with their GP, so we do not know to what extent this document could be helpful in making a truly shared and balanced decision about whether or not to taper ADM. Perhaps some of the reasons for not tapering that patients mentioned in the research interviews (e.g. fear of worsening, pain, social circumstances) already shaped their decision before even using the decision aid. Another possible explanation is that the decision aid was insufficiently personalized, despite being co-created with diverse stakeholders to ensure a wide scope of topics. We may need to investigate patient expectations and values and GP’s considerations on an individual level. For example, patients’ beliefs about the causes of their symptoms were not included in the decision aid. If many patients adopted a biomedical framework and believed that their depressive symptoms for example were due to a biochemical imbalance that needs to be restored with medication, the relatively low engagement in tapering is not surprising.The low participation rate in the MBCT intervention might have been due to our primary focus on withdrawal from ADM, so the resulting sample may have been less “mindfulness-minded” than a self-selecting sample. Perhaps patients who responded to our study invitation were interested in tapering their medication rather than in attending eight weekly 2,5 hour MBCT classes, despite being informed about the time investment of this intervention. Work and travel issues were the most common barriers for participation in MBCT.