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University of Exeter Medical School

Dr Joanne Butterworth

Dr Joanne Butterworth

NIHR Doctoral Research Fellow

 J.E.Butterworth@exeter.ac.uk

 01392 72 6362

 Smeall building Room 110

 

Smeall Building, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK


Overview

I am an academic GP with research interests in shared decision-making as a core component of patient-centred, personalised care.

I have been a member of the Exeter Collaboration for Academic Primary Care (APEx) at the University of Exeter since 2009, most recently securing a four-year NIHR-funded academic clinical lectureship, commencing October 2023.

I was among the first cohort of students to graduate from the Peninsula Medical School in 2007 and I undertook my foundation training as a doctor in Exeter. From there I began to develop an academic career alongside my GP training. I qualified as a GP in 2013 whilst simultaneously achieving a Masters in Primary Care research. I hold a doctoral fellowship award from the National Institute for Health and Care Research (NIHR) (£430,304; January 2018 – June 2023).

My PhD project was titled:

Development of a complex intervention (VOLITION) aimed at facilitating the involvement of older people living with multiple long-term conditions in decision-making about their health care during GP consultations.  

https://blogs.exeter.ac.uk/volition/

I work as a GP delivering clinical care. I have special interests in women’s health and I am competent to fit contraceptive devices.

I engage in teaching opportunities, with medical students, trainee GPs and peers, both within the university and at the GP practice.

I am a member of both training and capacity development and research planning groups for NIHR School for Primary Care Research (SPCR) at APEx.

I enjoy the balance of clinical and research commitments and find that each fuels my enthusiasm for the other. I also 'job share' with my husband, as Mum to our two gorgeous girls.

Qualifications

Doctor of Philosophy in Medical Studies, University of Exeter, 2023

Masters degree in Primary Care Research (MRes), University of Manchester (online learning), 2013

Membership of the Royal College of General Practitioners (MRCGP), 2013 

Diploma from the Faculty of Sexual and Reproductive Healthcare (DFSRH), 2012

Bachelor of Medicine Bachelor of Surgery (BMBS - Distinction), Peninsula Medical School, 2007 

Career

Academic training and experience

I acquired basic research skills during my undergraduate training and by undertaking a Masters degree in Primary Care Research (University of Manchester), before seeking more advanced training and experiences during my PhD:

Intervention development methods:

Complex intervention development and evaluation courses, DECIPHer, Cardiff (2018), Intervention Mapping summer residential course, Maastricht, The Netherlands (2018).

Systematic review methods:

Cochrane systematic review training modules, online (2018); Lead on a collaborative Cochrane review with national team (2018-19).

Quantitative methods:

Statistical modelling and logistic regression using STATA, University College London (2020); analysis of survey data whilst leading an independent study (2022).

Qualitative methods:

Advanced Qualitative Methods, University of Oxford (2019); Independent analysis of interview and focus group data during Masters studies (2019-22).

Trial Design:

Design and Analysis of Randomised Controlled Trials, Keele University (2019); Process Evaluation seminar series, University of Exeter (2019); Mentoring meetings with Clinical Trials Unit managers, Exeter (2018); Design and publication of randomised controlled feasibility trial protocol (2020).

Health Economics:

Basic Health Economics, online, University of Oxford (2021).

Research Management:

Good Clinical Practice training (last updated 2023); Ethics modules, Health Research Authority (2018); Leading three empirical PhD studies (2018-23).

Collaborations and Networking:

Multiple long-term conditions workshop, NIHR academy (2022); International Multimorbidity Symposium workshop, Sweden (2018).

Forming contacts at NHS England's institute for personalised care (Professor Alf Collins, Dr Adrian Hayter); Guidance from Professor Al Mulley (shared decision-making expert), Dartmouth Institute Global Health Care Delivery Science Program, USA (2019-present).

Patient and Public Involvement and Engagement (PPIE):

Coordination of a PPIE group: Eight members who contribute to 6-monthly planning meetings, provide feedback on participant-facing study materials, attend data interpretation workshops, and support grant proposals, with support of Applied Research Collaboration Southwest Peninsula (PenARC), (2018-present).

Research group links

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Research

Research interests

I was enthused to pursue an academic career following the publication of my undergraduate research. This was an independent, qualitative interview study that I carried out during my medical school elective placement on the Isles of Scilly, Cornwall.

My current research interests in shared decision-making and multiple long-term conditions began during an NIHR-funded Academic Clinical Fellowship: I published a secondary analysis of national survey data, identifying that patients’ reports of involvement in decision-making were more strongly associated with reports of trust in the GP among older people when compared with younger people.

The subsequent interview study became the dissertation paper for my Masters degree in Primary Care Research. I found that living with multiple long-term conditions affected patient experiences of involvement. I planned my PhD studies to address the gaps in the evidence, with a view to improving the quality of patient care.

Research projects

My NIHR-funded PhD (£430,304; January 2018 – June 2023) was titled:

Development of a complex intervention (‘VOLITION’) aimed at facilitating the involvement of older people living with multiple long-term conditions (MLTC) in decision-making about their health care during GP consultations.

https://blogs.exeter.ac.uk/volition/

What did I do?

Six-step Intervention Mapping (IM) was a framework to support the development of VOLITION and its applicability to day-to-day practice. A project planning group was established, including members of the public, GPs with interests in older people, and experts on shared decision-making (SDM). Three core studies provided a platform to complete steps 1-5 of IM, with a view to testing VOLITION (step 6) as post-doctoral work.

Research methods:

  • Cochrane systematic review of similar interventions. The review informed the early logic models of IM, and the constituent components of VOLITION were subsequently outlined.
  • A focus group study enabled the refinement of behaviour-change objectives for both patients and GPs, which in turn informed the refinement of intervention components.  
  • A mixed-methods sequential-explanatory study involved analysis of survey data followed by qualitative interviews, and informed plans to implement VOLITION in the context of remote vs. face-to-face consultations. This context was important following the organisational changes to general practice driven by the COVID-19 pandemic.

What were the findings and what impact have they had?

Contribution to practice:

The PhD studies enabled the development of a new SDM intervention, applicable to conversations surrounding the diagnosis, treatment and management of older people living with MLTC during general practice consultations. Worldwide, the prevalence of MLTC increases with age. These individuals live with a burden of disease and treatment. The management of patients with MLTC poses challenges for those striving to deliver high-quality care. The IM approach utilised both theory and evidence to inform the development of a transparent intervention to support the management of older people living with MLTC. 

VOLITION consists of:

i) a prompt to patients, inviting them to express their personal preferences for involvement as well as their fundamental priorities and life goals to the GP, and

ii) training for GPs; delivering a responsive patient-tailored approach to SDM, tackling challenges perceived by GPs regarding implementation in practice. These challenges include the handling of clinical uncertainty when addressing patient priorities in the absence of relevant evidence-based guidelines.

Translation into services:

VOLITION fits with NHS England’s universal personalised care plan; to empower patients in the management of their healthcare and to train clinicians in SDM. Next steps are to feasibilty test and evaluate VOLITION with a view to ensuring its implementation and sustainability in day-to-day practice. A grant application is under preparation, to lead a collaborative feasibility trial of the VOLITION intervention, working with university teams nationally. 

Research networks

I am a co-applicant on the NIHR School for Primary Care Research (SPCR) £45,000 ‘PFlexi’ study: ‘Implementing a training package for primary care clinicians to support women to do their Pelvic Floor Muscle Exercises for the prevention and management of incontinence’. The study is currently underway and is led by Professor Sarah Dean and Dr Emma Pitchforth in Exeter.

I am a co-applicant on the NIHR SPCR £116,622 ‘D-PiLL’ study: ‘Quantifying the risks of deprescribing of long-term cardiovascular medicines in people with limited life expectancy’. This study is led by Professor Rupert Payne and Professor Gary Abel in Exeter and is due to commence in July 2023.

I am a collaborator on the ‘INDEX’ study: ‘Improving uNderstanding of bone DEnsity (dXa) scans’. The study is led by Professor Zoe Paskins and Dr Laurna Bullock from Keele University. The study is funded by the Royal Osteoporosis Society. 

Research grants

  • 2017 National Institute for Health and Care Research
    Doctoral Research Fellowship - £430,304 personal award (2018-23)
  • 2016 South West General Practice Trust
    Research funding - £15,000 personal award (2016-17) to support development of a research proposal and application for further funding
  • 2013 National Institute for Health and Care Research
    In-Practice Fellowship - £93,066 personal award (2013-15)
  • 2009 National Institute for Health and Care Research
    Academic Clinical Fellowship - £7,500 award (2009-13) held by supporting organisations (University of Exeter/ GP practice), awarded by competitive process.

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Publications

Journal articles

Nyamapfene T, Butterworth J, Merchant H, Eaton M (2022). GPs’ perceptions of teaching methods in shared decision-making training: a qualitative study. British Journal of General Practice, 73(729), e310-e317. Abstract.
Brown EL, Poltawski L, Pitchforth E, Richards SH, Campbell JL, Butterworth JE (2022). Shared decision-making between older people with multimorbidity and GPs: focus group study. British Journal of General Practice, 72(721).
Butterworth JE, Hays R, McDonagh STJ, Bower P, Pitchforth E, Richards SH, Campbell JL (2020). Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged). Patient Educ Couns, 103(10), 2078-2094. Abstract.  Author URL.
Butterworth J, Richards S, Warren F, Pitchforth E, Campbell J (2020). Randomised feasibility trial and embedded qualitative process evaluation of a new intervention to facilitate the involvement of older patients with multimorbidity in decision-making about their healthcare during general practice consultations: the VOLITION study protocol. Pilot Feasibility Stud, 6 Abstract.  Author URL.
Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J (2019). Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database of Systematic Reviews
Butterworth JE, Hays R, Richards SH, Bower P, Campbell J (2018). Interventions for involving older patients with multimorbidity in decision-making during primary care consultations. Cochrane Database of Systematic Reviews, 2018(9). Abstract.
Butterworth JE, Hays R, Richards SH, Bower P, Campbell J (2018). Interventions for involving older patients with multimorbidity in decision‐making during primary care consultations (Protocol). Cochrane Database of Systematic Reviews, Issue 9. Art. No.: CD013124. DOI: 10.1002/14651858.CD013124.
Butterworth J, Sansom A, Sims L, Healey M, Kingsland E, Campbell J (2017). Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study. Br J Gen Pract, 67(662), e650-e658. Abstract.  Author URL.
Butterworth JE, Campbell JL (2014). Older patients and their GPs: shared decision making in enhancing trust. Br J Gen Pract, 64(628), e709-e718. Abstract.  Author URL.
Croker JE, Swancutt DR, Roberts MJ, Abel GA, Roland M, Campbell JL (2013). Factors affecting patients' trust and confidence in GPs: Evidence from the English national GP patient survey. BMJ Open, 3(5). Abstract.
Croker JE, Campbell JL (2009). Satisfaction with access to healthcare: Qualitative study of rural patients and practitioners. Primary Health Care Research and Development, 10(4), 309-319. Abstract.

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External Engagement and Impact

I was an organising committee member for the UK Society for Academic Primary Care (SAPC) annual scientific meeting (ASM), held at the University of Exeter in 2019. 

As a SAPC ambassador, I led the agenda surrounding Early Career Researchers (ECR) and organised an ECR workshop titled ‘ECR Solution Room’. The workshop was well received, and I delivered it again the following year at the ASM hosted by the University of Leeds.

Collaborative relationships

I have formed a collaborative relationship with the Dartmouth Institute’s Global Health Care Delivery Science Program, New Hampshire, USA: I invited Professor Al Mulley (whose extensive expertise includes shared decision-making) to give a seminar at the University of Exeter. 

I attended a national leadership programme for GPs; ‘Next Generation GP’. I met and remain in touch with Professor Alf Collins (leader in shared decision-making practice and policy), who invited me to join NHS England’s Institute for Personalised Care group. I am currently using these contacts to explore avenues for the implementation of my PhD research in practice.

Presentations

International

International shared decision-making society conference (2022), Kolding, Denmark. An oral presentation to researchers and clinicians, outlining the findings from the three core studies of my PhD and their application to the six steps of the Intervention Mapping framework in the development of the VOLITION intervention.

Invited speaker: Leeds Unit for Complex Intervention Development / The Research Centre for Patient Involvement (2022), University of Leeds, UK. An oral (online) presentation of the use of Intervention Mapping in the development of the VOLITION intervention (PhD project).

National

Society for Academic Primary Care annual scientific meeting (2021), hosted by the University of Leeds, UK. An online poster presentation outlining the use of the Intervention Mapping framework in the development of the VOLITION intervention.

Society for Academic Primary Care annual scientific meeting (2019) at the University of Exeter. In-person, oral presentation of ‘The Exeter Statement’ to the whole conference audience (400+ attendees). The presentation was given to coincide with the World Health Organisation’s Primary Care Declaration of Astana and was on behalf of all senior team members at the Exeter Collaboration for Academic Primary Care.

Society for Academic Primary Care annual scientific meeting (2019) at the University of Exeter. An in-person, oral presentation of findings from the Cochrane systematic review and the findings from the Refining VOLITION study relating to intervention development.

Generating impact from publication

First author of Cochrane systematic review, ranked top 5 (altmetric 50) in 2019, published on the Cochrane Library App and promoted by the World Health Organisation (WHO) in 2020:

I led this systematic review, collaborating with university colleagues in Exeter, Manchester and Leeds, as the first of three work packages during my PhD. The special edition Cochrane Library App was curated by Cochrane Campbell Global Ageing Partnership to coincided with the publication of WHO’s Baseline Report for the Decade of Healthy Ageing 2020-2030. The review was published on the App and promoted by WHO.

First author of a top 10 ‘most read’ paper in the British Journal of General Practice (2017):

I carried out 30-minute telephone interviews with sixteen pharmacists, analysed the transcribed data thematically, and led the team in the publication of results.

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Teaching

Postgraduate teaching

I have experience of supervising Academic Clinical Fellows (ACFs), 2020-present. Core supervision includes project planning, methodological guidance, and review of scientific writing with successful publication.

Undergraduate teaching

I have supervised an intercalating medical student in their dissertation project for a Masters degree in Medical Education (2021) with a subsequent paper published in BJGP.

I authored and recorded a 60-minute lecture which is in current use by medical students at the University of Exeter (2020-present). ‘Shared decision-making for older people with multiple long-term conditions’.

I lead a Special Study Unit for first year medical students (2019-present). ‘Shared decision-making for multiple long-term conditions’. Students attend three interactive teaching sessions, produce a short presentation, and write a review article of relevant research literature.

I am a small group facilitator for the University of Exeter medical school BMBS ‘Making sense of Evidence’ programme (2018-present). I facilitate students’ critical appraisal of research papers, enabling them to develop key skills of relevance to several research methodologies.

Teaching in my clinical role

I have supervised GP trainees and medical students during their clinical placements in GP surgeries over the last five years. I am a trained assessor and I regularly provide summative feedback to students on placement.

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