Facilitators and Barriers in Anorexia Nervosa - Treatment Initiation

NCT ID: NCT03713541

Last Updated: 2020-11-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

450 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-05-01

Study Completion Date

2022-04-30

Brief Summary

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Anorexia nervosa (AN) is a comparably low-prevalent illness. Chronic courses are often and the mortality rate of patients with AN is higher than in any other mental illness. A major influence on the course of the illness is the interval between the onset of AN symptoms and the beginning of an adequate treatment (duration of untreated illness, DUI). Patients with AN have a better prognosis if treated early. Previous large-scale interventions have not shown the desired positive effects on the DUI. Therefore, an important starting point seems to be a better initial understanding of the factors influencing the DUI, which is the major aim of this project.

The planned mixed-method study is divided in three consecutive sub-studies. The first substudy aims to identify modifiable factors influencing the DUI using semi-structured interviews and a multi-informant approach (patients, carers, physicians). As a result of this qualitative analyses using Grounded Theory the most relevant factors will be determined. The motivation of the second substudy is to condense the factors identified to influence the DUI into a checklist and to conduct a first psychometric evaluation of this newly developed instrument. The third substudy aims to quantitatively determine the magnitude of the effects of a) a priori determined non-modifiable factors and b) the modifiable checklist-factors using a multi-informant approach (planned n for each informant = 130; 13 co-operating specialized clinics and 6 cooperating outpatient partners). Additional outpatient partners may be recruited during the course of the study.

In conclusion, the study aims to derive recommendations for effective secondary prevention. Thereby, the study might ultimately contribute to earlier treatment initiation of patients with AN, and to the prevention of chronic courses and the associated high health care costs and individual burden.

Detailed Description

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Anorexia nervosa (AN) is a comparably low-prevalent, yet due to its somatic and mental consequences serious illness. Chronic courses are often and the mortality rate of patients with AN is higher than in any other mental illness.

A major influence on the course of the illness is the interval between the onset of AN symptoms and the beginning of an adequate treatment (duration of untreated illness, DUI). That is, patients with AN have a better prognosis if treated early. Previous large-scale interventions have not shown the desired positive effects on the DUI. Therefore, an important starting point seems to be a better initial understanding of the factors influencing the DUI, which is the major aim of this project. Based on this evidence, this study aims to derive recommendations for effective secondary prevention.

To our very best knowledge this is the first study investigating factors influencing the DUI using a multi-informant strategy, that is exploring the perspective of patients with AN, their significant carers and involved physicians. Furthermore, the study will avoid the confounding of patients with different eating disorder diagnoses, i.e. it will include exclusively patients with AN. Finally, there will be a clear focus on factors which are modifiable and precise in their definition.

The planned mixed-method study is divided in three consecutive sub-studies. The first substudy aims to identify modifiable factors influencing the DUI using semi-structured interviews and a multi-informant approach (patients, carers, physicians). As a result of this qualitative analyses using Grounded Theory the most relevant factors will be determined. The motivation of the second substudy is to condense the factors identified to influence the DUI into a checklist and to conduct a first psychometric evaluation of this newly developed instrument. The third substudy aims to quantitatively determine the magnitude of the effects of a) a priori determined non-modifiable factors and b) the modifiable checklist-factors using a multi-informant approach (planned n for each informant = 130; 13 co-operating specialized clinics and 6 cooperating outpatient partners). Additional outpatient partners may be recruited during the course of the study.

In conclusion, the study aims to derive recommendations for effective secondary prevention. Thereby, the study might ultimately contribute to earlier treatment initiation of patients with AN, and to the prevention of chronic courses and the associated high health care costs and individual burden.

Conditions

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Anorexia Nervosa Feeding and Eating Disorders of Childhood

Keywords

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Anorexia nervosa [MeSH] Feeding and Eating Disorders [MeSH] women youth adolescent duration of untreated illness (DUI) time-to-treatment [MeSH] facilitators barriers factors treatment first treatment initiation

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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Patients with Anorexia nervosa (AN)

Female patients with Anorexia nervosa (AN, ICD-10: F50.0/1) of 14 years and older, receiving an initial treatment due to their AN (start of initial treatment no longer than 3 months ago, inpatient care: at least 7 days inpatient; outpatient care: at least 5 sessions with the same therapist) with sufficient language skills and no serious organic or psychiatric illnesses and no acute suicidality will be consecutively included in the study. No intervention.

No intervention

Intervention Type OTHER

Survey during normal supply.

Carers of patients with AN

Significant caregivers in AN patients aged 14 to 15 years: parents; in AN patients aged 16 years and over: parents or other significant carer. No intervention.

No intervention

Intervention Type OTHER

Survey during normal supply.

Physicians of patients with AN

Resident general practitioner, pediatrician, internist or gynecologist with at least one medical patient contact within the last 12 months. No intervention.

No intervention

Intervention Type OTHER

Survey during normal supply.

Interventions

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No intervention

Survey during normal supply.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Female patients, 14 years and older
* Treatment diagnosis anorexia nervosa (ICD-10: F50.0/1)
* Initial treatment (start of initial treatment no longer than 3 months ago)
* Inpatient care: at least 7 days inpatient
* Outpatient care: at least 5 sessions with the same therapist


* in AN patients aged 14 to 15 years: parents ; in AN patients aged 16 years and over: parents or other significant carer
* Informed consent
* Consent of the patient


* Resident general practitioner, pediatrician, internist or gynecologist
* At least one medical patient contact within the last 12 months
* Informed consent
* Consent of the patient and release from confidentiality

Exclusion Criteria

* Insufficient language skills
* Serious organic or psychiatric illnesses
* Acute suicidality

Significant caregiver


Physician


\- Insufficient language skills
Minimum Eligible Age

14 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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German Research Foundation

OTHER

Sponsor Role collaborator

Universitätsklinikum Hamburg-Eppendorf

OTHER

Sponsor Role lead

Responsible Party

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Prof. Dr. Antje Gumz

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Antje Gumz, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Universitätsklinikum Hamburg-Eppendorf

Bernd Loewe, Prof. Dr.

Role: PRINCIPAL_INVESTIGATOR

Universitätsklinikum Hamburg-Eppendorf

Locations

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Schön Clinic Roseneck

Prien am Chiemsee, Bavaria, Germany

Site Status RECRUITING

Schön Clinic Bad Bramstedt

Bad Bramstedt, Schleswig-Holstein, Germany

Site Status RECRUITING

Curtius-Clinic, Specialist Clinic for Psychosomatics and Psychotherapeutic Medicine

Malente, Schleswig-Holstein, Germany

Site Status RECRUITING

Schön Clinic Bad Arolsen

Bad Arolsen, , Germany

Site Status RECRUITING

Clinic Lüneburger Heide

Bad Bevensen, , Germany

Site Status RECRUITING

MediClin Seepark Clinic

Bodenteich, , Germany

Site Status RECRUITING

Timmermann & Partner, Medical care center for physical and mental health

Cuxhaven, , Germany

Site Status RECRUITING

Department of Child and Adolescent Psychiatry of the University Medical Center Hamburg-Eppendorf (UKE)

Hamburg, , Germany

Site Status ACTIVE_NOT_RECRUITING

Local psychotherapists

Hamburg, , Germany

Site Status ENROLLING_BY_INVITATION

Behavior therapy Falkenried MVZ GmbH

Hamburg, , Germany

Site Status RECRUITING

VT Falkenried Training and Education

Hamburg, , Germany

Site Status RECRUITING

Department of Psychosomatic Medicine and Psychotherapy, Asklepios West Clinic Hamburg

Hamburg, , Germany

Site Status RECRUITING

Schön Clinic Eilbek

Hamburg, , Germany

Site Status RECRUITING

Schön Clinic Hamburg Eilbek

Hamburg, , Germany

Site Status RECRUITING

Institute for Behavior Therapy Education Hamburg (IVAH)

Hamburg, , Germany

Site Status ENROLLING_BY_INVITATION

Asklepios Clinic Nord - Ochsenzoll

Hamburg, , Germany

Site Status RECRUITING

University Clinic Regensburg

Regensburg, , Germany

Site Status RECRUITING

Evangelic hospital Ginsterhof HmbH

Rosengarten, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Angelika Weigel, Dr.

Role: CONTACT

Phone: +4915222827125

Email: [email protected]

Laurence Reuter, Dr.

Role: CONTACT

Phone: +4915222815684

Email: [email protected]

Facility Contacts

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Ulrich Voderholzer, Prof. Dr.

Role: primary

Bernhard Osen, Dr.

Role: primary

Silke Kleinschmidt, Dr.

Role: primary

M Seidel, Dr. med.

Role: primary

W Wünsch-Leiteritz, Dr. med.

Role: primary

Schwennen, Dr

Role: primary

S Rieper

Role: primary

Kiki Peter

Role: primary

Roman Wessels

Role: primary

Helge Fehrs, Dr.

Role: primary

Rebecca Albrecht, Dr.

Role: primary

Rebecca Albrecht, Dr.

Role: primary

Silke Hagena, Dipl.-Psych.

Role: primary

Rumoald Brunner, Prof. Dr.

Role: primary

Ute-Christine Haberer, Dr. med.

Role: primary

References

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Reuter L, Kastner D, Schmidt J, Weigel A, Voderholzer U, Seidel M, Schwennen B, Fehrs H, Lowe B, Gumz A. The development and psychometric evaluation of FABIANA-checklist: a scale to assess factors influencing treatment initiation in anorexia nervosa. J Eat Disord. 2021 Nov 3;9(1):144. doi: 10.1186/s40337-021-00490-w.

Reference Type DERIVED
PMID: 34732246 (View on PubMed)

Kastner D, Weigel A, Buchholz I, Voderholzer U, Lowe B, Gumz A. Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals. J Eat Disord. 2021 Feb 27;9(1):28. doi: 10.1186/s40337-021-00381-0.

Reference Type DERIVED
PMID: 33640028 (View on PubMed)

Kastner D, Buchholz I, Weigel A, Brunner R, Voderholzer U, Gumz A, Lowe B. Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study. BJPsych Open. 2019 Oct 21;5(6):e92. doi: 10.1192/bjo.2019.77.

Reference Type DERIVED
PMID: 31631825 (View on PubMed)

Other Identifiers

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LO 766/16-1m; GU 156

Identifier Type: -

Identifier Source: org_study_id