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.
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 salaried 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
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
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:
- A 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.
Publications
Key publications | Publications by category | Publications by year
Publications by category
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, BJGP.2022.0194-BJGP.2022.0194.
Abstract:
GPs’ perceptions of teaching methods in shared decision-making training: a qualitative study
BackgroundAlthough shared decision making (SDM) is key to delivering patient-centred care, there are barriers to GPs implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs’ perceptions of the delivery of SDM training in general practice remain largely unexplored.AimTo explore GPs’ perceptions of teaching methods in SDM training.Design and settingQualitative study of GPs with teaching roles at the University of Exeter Medical School.MethodPurposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis.ResultsThree themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that mostly informed their SDM in clinical practice positively. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, although most learning occurred implicitly through reflections on their clinical experiences. The GPs identified that their training on SDM should reflect the uncertainty that is present when sharing decisions with patients in real-life general practice consultations. GPs also identified the targeting of individual GPs’ SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice.ConclusionTo the authors’ knowledge, this is the first UK study to explore GPs’ perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients’ views alongside those of GPs in the evaluation of future programmes.
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:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).
OBJECTIVE: to assess the effects of interventions aimed at involving older people with multimorbidity in decision-making about their healthcare during primary care consultations. METHODS: Cochrane methodological procedures were applied. Searches covered all relevant trial registries and databases. Randomised controlled trials were identified where interventions had been compared with usual care/ control/ another intervention. A narrative synthesis is presented; meta-analysis was not appropriate. RESULTS: 8160 abstracts and 54 full-text articles were screened. Three studies were included, involving 1879 patient participants. Interventions utilised behaviour change theory; cognitive-behavioural therapy and motivational interviewing; multidisciplinary, holistic patient review and organisational changes. No studies reported the primary outcome 'patient involvement in decision-making about their healthcare'. Patient involvement was evident in the theory underpinning interventions. Certainty of evidence (assessed using GRADE) was limited by small studies and inconsistency in secondary outcomes measured. CONCLUSION: the evidence base is currently too limited to interpret with certainty. Transparency in design and consistency in evaluation, using validated measures, is required for future interventions involving older patients with multimorbidity in decisions about their healthcare. PRACTICE IMPLICATIONS: There is a large gap between clinical guidelines for multimorbidity and an evidence base for implementation of their recommendations during primary care consultations with older people.
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,
6Abstract:
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.
BACKGROUND: the number of older people with multiple health problems is increasing worldwide. This creates a strain on clinicians and the health service when delivering clinical care to this patient group, who themselves carry a large treatment burden. Despite shared decision-making being acknowledged by healthcare organisations as a priority feature of clinical care, older patients with multimorbidity are less often involved in decision-making when compared with younger patients, with some evidence suggesting associated health inequalities. Interventions aimed at facilitating shared decision-making between doctors and patients are outdated in their assessments of today's older patient population who need support in prioritising complex care needs in order to maximise quality of life and day-to-day function. AIMS: to undertake feasibility testing of an intervention ('VOLITION') aimed at facilitating the involvement of older patients with more than one long-term health problem in shared decision-making about their healthcare during GP consultations.To inform the design of a fully powered trial to assess intervention effectiveness. METHODS: This study is a cluster randomised controlled feasibility trial with qualitative process evaluation interviews. Participants are patients, aged 65 years and above with more than one long-term health problem (multimorbidity), and the GPs that they consult with. This study aims to recruit 6 GP practices, 18 GPs and 180 patients. The intervention comprises two components: (i) a half-day training workshop for GPs in shared decision-making; and (ii) a leaflet for patients that facilitate their engagement with shared decision-making. Intervention implementation will take 2 weeks (to complete delivery of both patient and GP components), and follow-up duration will be 12 weeks (from index consultation and commencement of data collection to final case note review and process evaluation interview). The trial will run from 01/01/20 to 31/01/21; 1 year 31 days. DISCUSSION: Shared decision-making for older people with multimorbidity in general practice is under-researched. Emerging clinical guidelines advise a patient-centred approach, to reduce treatment burden and focus on quality of life alongside disease control. The systematic development, testing and evaluation of an intervention is warranted and timely. This study will test the feasibility of implementing a new intervention in UK general practice for future evaluation as a part of routine care. TRIAL REGISTRATION: CLINICAL TRIALS.GOV registration number NCT03786315, registered 24/12/18.
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:
Interventions for involving older patients with multimorbidity in decision-making during primary care consultations
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: to explore the effectiveness of interventions delivered with the aim of involving older patients with multimorbidity in decision-making about their health care during primary care consultations.
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:
Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study.
BACKGROUND: UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative '10-point GP workforce action plan'. AIM: to explore pharmacists' perceptions of primary care roles including the potential for greater integration of their profession into general practice. DESIGN AND SETTING: a qualitative interview study in UK primary care carried out between October 2015 and July 2016. METHOD: Pharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted - one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used. RESULTS: Sixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants' experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role. CONCLUSION: There is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.
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:
Older patients and their GPs: shared decision making in enhancing trust.
BACKGROUND: Older patients differ from younger patients in their perceptions of trust in doctors; their sense of shared decision making is particularly associated with their trust in the GP. Enhancing trust and improving shared decision making are thought to have positive health outcomes. Older patients are sometimes reported as being less frequently involved in decisions about their health care, however, and in having more unmet healthcare needs than younger patients. AIM: This study explored older patients' trust in their GPs and their perceptions of shared decision making. DESIGN AND SETTING: Qualitative methods were used. Systematic sampling identified 20 participants, aged ≥65 years, from three GP surgeries in Devon, UK. METHOD: a constant comparative approach was applied to thematic analysis of transcribed interviews. RESULTS: all participants valued feeling involved in decisions but differed regarding how they felt involved. Trust influenced preferences for shared decision making: a trusted GP 'ally', to competently manage participants' increasing health-information requirements throughout the vulnerable ageing process, was important. Trust was affected by factors contributing to the facilitation of involvement. GP characteristics, communication skills, consultation duration, and continuity of care were common themes. CONCLUSION: Although limited geographically and subsequently by ethnic group, the present sample allows for reasonable transferability of the study to other UK populations. A range of factors are highlighted for consideration when planning primary healthcare delivery: to facilitate the optimal involvement of older patients in decisions about their health care, while enhancing their trust in the GP; to help minimise potential health inequalities for this patient group.
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:
Factors affecting patients' trust and confidence in GPs: Evidence from the English national GP patient survey
Objectives: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. Design: Secondary analysis of English national GP patient survey data (2009). Setting: Primary Care, England, UK. Participants: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. Outcome measures: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. Results: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. Conclusions: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor.
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:
Satisfaction with access to healthcare: Qualitative study of rural patients and practitioners
To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community. General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required. Qualitative interviews with patients and primary healthcare practitioners. Isles of Scilly, Cornwall, UK. A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically. Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient–practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare. Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes. © 2009, Cambridge University Press. All rights reserved.
Abstract.
Publications by year
2022
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, BJGP.2022.0194-BJGP.2022.0194.
Abstract:
GPs’ perceptions of teaching methods in shared decision-making training: a qualitative study
BackgroundAlthough shared decision making (SDM) is key to delivering patient-centred care, there are barriers to GPs implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs’ perceptions of the delivery of SDM training in general practice remain largely unexplored.AimTo explore GPs’ perceptions of teaching methods in SDM training.Design and settingQualitative study of GPs with teaching roles at the University of Exeter Medical School.MethodPurposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis.ResultsThree themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that mostly informed their SDM in clinical practice positively. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, although most learning occurred implicitly through reflections on their clinical experiences. The GPs identified that their training on SDM should reflect the uncertainty that is present when sharing decisions with patients in real-life general practice consultations. GPs also identified the targeting of individual GPs’ SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice.ConclusionTo the authors’ knowledge, this is the first UK study to explore GPs’ perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients’ views alongside those of GPs in the evaluation of future programmes.
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).
2020
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:
Involving older people with multimorbidity in decision-making about their primary healthcare: a Cochrane systematic review of interventions (abridged).
OBJECTIVE: to assess the effects of interventions aimed at involving older people with multimorbidity in decision-making about their healthcare during primary care consultations. METHODS: Cochrane methodological procedures were applied. Searches covered all relevant trial registries and databases. Randomised controlled trials were identified where interventions had been compared with usual care/ control/ another intervention. A narrative synthesis is presented; meta-analysis was not appropriate. RESULTS: 8160 abstracts and 54 full-text articles were screened. Three studies were included, involving 1879 patient participants. Interventions utilised behaviour change theory; cognitive-behavioural therapy and motivational interviewing; multidisciplinary, holistic patient review and organisational changes. No studies reported the primary outcome 'patient involvement in decision-making about their healthcare'. Patient involvement was evident in the theory underpinning interventions. Certainty of evidence (assessed using GRADE) was limited by small studies and inconsistency in secondary outcomes measured. CONCLUSION: the evidence base is currently too limited to interpret with certainty. Transparency in design and consistency in evaluation, using validated measures, is required for future interventions involving older patients with multimorbidity in decisions about their healthcare. PRACTICE IMPLICATIONS: There is a large gap between clinical guidelines for multimorbidity and an evidence base for implementation of their recommendations during primary care consultations with older people.
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,
6Abstract:
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.
BACKGROUND: the number of older people with multiple health problems is increasing worldwide. This creates a strain on clinicians and the health service when delivering clinical care to this patient group, who themselves carry a large treatment burden. Despite shared decision-making being acknowledged by healthcare organisations as a priority feature of clinical care, older patients with multimorbidity are less often involved in decision-making when compared with younger patients, with some evidence suggesting associated health inequalities. Interventions aimed at facilitating shared decision-making between doctors and patients are outdated in their assessments of today's older patient population who need support in prioritising complex care needs in order to maximise quality of life and day-to-day function. AIMS: to undertake feasibility testing of an intervention ('VOLITION') aimed at facilitating the involvement of older patients with more than one long-term health problem in shared decision-making about their healthcare during GP consultations.To inform the design of a fully powered trial to assess intervention effectiveness. METHODS: This study is a cluster randomised controlled feasibility trial with qualitative process evaluation interviews. Participants are patients, aged 65 years and above with more than one long-term health problem (multimorbidity), and the GPs that they consult with. This study aims to recruit 6 GP practices, 18 GPs and 180 patients. The intervention comprises two components: (i) a half-day training workshop for GPs in shared decision-making; and (ii) a leaflet for patients that facilitate their engagement with shared decision-making. Intervention implementation will take 2 weeks (to complete delivery of both patient and GP components), and follow-up duration will be 12 weeks (from index consultation and commencement of data collection to final case note review and process evaluation interview). The trial will run from 01/01/20 to 31/01/21; 1 year 31 days. DISCUSSION: Shared decision-making for older people with multimorbidity in general practice is under-researched. Emerging clinical guidelines advise a patient-centred approach, to reduce treatment burden and focus on quality of life alongside disease control. The systematic development, testing and evaluation of an intervention is warranted and timely. This study will test the feasibility of implementing a new intervention in UK general practice for future evaluation as a part of routine care. TRIAL REGISTRATION: CLINICAL TRIALS.GOV registration number NCT03786315, registered 24/12/18.
Abstract.
Author URL.
2019
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
2018
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:
Interventions for involving older patients with multimorbidity in decision-making during primary care consultations
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: to explore the effectiveness of interventions delivered with the aim of involving older patients with multimorbidity in decision-making about their health care during primary care consultations.
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.
2017
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:
Pharmacists' perceptions of their emerging general practice roles in UK primary care: a qualitative interview study.
BACKGROUND: UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative '10-point GP workforce action plan'. AIM: to explore pharmacists' perceptions of primary care roles including the potential for greater integration of their profession into general practice. DESIGN AND SETTING: a qualitative interview study in UK primary care carried out between October 2015 and July 2016. METHOD: Pharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted - one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used. RESULTS: Sixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants' experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role. CONCLUSION: There is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.
Abstract.
Author URL.
2014
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:
Older patients and their GPs: shared decision making in enhancing trust.
BACKGROUND: Older patients differ from younger patients in their perceptions of trust in doctors; their sense of shared decision making is particularly associated with their trust in the GP. Enhancing trust and improving shared decision making are thought to have positive health outcomes. Older patients are sometimes reported as being less frequently involved in decisions about their health care, however, and in having more unmet healthcare needs than younger patients. AIM: This study explored older patients' trust in their GPs and their perceptions of shared decision making. DESIGN AND SETTING: Qualitative methods were used. Systematic sampling identified 20 participants, aged ≥65 years, from three GP surgeries in Devon, UK. METHOD: a constant comparative approach was applied to thematic analysis of transcribed interviews. RESULTS: all participants valued feeling involved in decisions but differed regarding how they felt involved. Trust influenced preferences for shared decision making: a trusted GP 'ally', to competently manage participants' increasing health-information requirements throughout the vulnerable ageing process, was important. Trust was affected by factors contributing to the facilitation of involvement. GP characteristics, communication skills, consultation duration, and continuity of care were common themes. CONCLUSION: Although limited geographically and subsequently by ethnic group, the present sample allows for reasonable transferability of the study to other UK populations. A range of factors are highlighted for consideration when planning primary healthcare delivery: to facilitate the optimal involvement of older patients in decisions about their health care, while enhancing their trust in the GP; to help minimise potential health inequalities for this patient group.
Abstract.
Author URL.
2013
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:
Factors affecting patients' trust and confidence in GPs: Evidence from the English national GP patient survey
Objectives: Patients' trust in general practitioners (GPs) is fundamental to effective clinical encounters. Associations between patients' trust and their perceptions of communication within the consultation have been identified, but the influence of patients' demographic characteristics on these associations is unknown. We aimed to investigate the relative contribution of the patient's age, gender and ethnicity in any association between patients' ratings of interpersonal aspects of the consultation and their confidence and trust in the doctor. Design: Secondary analysis of English national GP patient survey data (2009). Setting: Primary Care, England, UK. Participants: Data from year 3 of the GP patient survey: 5 660 217 questionnaires sent to patients aged 18 and over, registered with a GP in England for at least 6 months; overall response rate was 42% after adjustment for sampling design. Outcome measures: We used binary logistic regression analysis to investigate patients' reported confidence and trust in the GP, analysing ratings of 7 interpersonal aspects of the consultation, controlling for patients' sociodemographic characteristics. Further modelling examined moderating effects of age, gender and ethnicity on the relative importance of these 7 predictors. Results: Among 1.5 million respondents (adjusted response rate 42%), the sense of 'being taken seriously' had the strongest association with confidence and trust. The relative importance of the 7 interpersonal aspects of care was similar for men and women. Non-white patients accorded higher priority to being given enough time than did white patients. Involvement in decisions regarding their care was more strongly associated with reports of confidence and trust for older patients than for younger patients. Conclusions: Associations between patients' ratings of interpersonal aspects of care and their confidence and trust in their GP are influenced by patients' demographic characteristics. Taking account of these findings could inform patient-centred service design and delivery and potentially enhance patients' confidence and trust in their doctor.
Abstract.
2009
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:
Satisfaction with access to healthcare: Qualitative study of rural patients and practitioners
To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community. General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required. Qualitative interviews with patients and primary healthcare practitioners. Isles of Scilly, Cornwall, UK. A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically. Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient–practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare. Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes. © 2009, Cambridge University Press. All rights reserved.
Abstract.
Joanne_Butterworth Details from cache as at 2023-03-31 12:40:33
Refresh publications
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.
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.
