TY - JOUR
T1 - Nurse practitioner-delivered cognitive–behavioral treatment as a novel implementation route for irritable bowel syndrome
T2 - A proof of concept
AU - Burton Murray, Helen
AU - Weeks, Imani
AU - Thurler, Andrea
AU - Calabrese, Samantha
AU - Kate Lapinel, Mary
AU - Madva, Elizabeth N.
AU - Staller, Kyle
AU - Keefer, Laurie
AU - Kuo, Braden
N1 - Funding Information:
This study was funded by the Harvard Medical School Livingston Fellowship Award (Burton Murray PI) and internal funds (the Massachusetts General Hospital Division of Gastroenterology GI Innovation and Collaboration Award). This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases—K23 DK120945 (KS) and K23 DK131334 (HBM). Our funding sources played no role in study design, data collection, data analysis and interpretation, writing of the report, or in the decision to submit the article for publication. We thank Alison Krustapentus, CNP, Fatima Rao, BA, Madison Lacasse, BA, and Isabelle Garcia-Fischer for their contributions to development of the treatment materials used in this study and study preparation; and to Noah Ashenafi for contributions to preliminary data analysis during a summer internship funded by the American Gastroenterological Association SURF program.
Funding Information:
This study was funded by the Harvard Medical School Livingston Fellowship Award (Burton Murray PI) and internal funds (the Massachusetts General Hospital Division of Gastroenterology GI Innovation and Collaboration Award). This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases—K23 DK120945 (KS) and K23 DK131334 (HBM). Our funding sources played no role in study design, data collection, data analysis and interpretation, writing of the report, or in the decision to submit the article for publication. We thank Alison Krustapentus, CNP, Fatima Rao, BA, Madison Lacasse, BA, and Isabelle Garcia‐Fischer for their contributions to development of the treatment materials used in this study and study preparation; and to Noah Ashenafi for contributions to preliminary data analysis during a summer internship funded by the American Gastroenterological Association SURF program.
Publisher Copyright:
© 2023 John Wiley & Sons Ltd.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Exposure-based cognitive–behavioral therapy (exposure-CBT) is efficacious for irritable bowel syndrome (IBS). However, few patients receive exposure-CBT due to a lack of behavioral health providers trained in brain–gut behavior therapies. Nurse practitioners (NPs) could fill a critical need for scalable delivery methods. In a pragmatic investigation of a 5-session NP-delivered exposure-CBT for adults with Rome IV-defined IBS, we evaluated treatment feasibility and acceptability and explored changes clinical outcomes. Methods: Exposure-CBT was delivered as part of routine care involving four sessions every other week and a 2-month booster session. Patients could electively participate in an observational study including pre-, mid-, and post-treatment surveys and a post-treatment qualitative interview. Independently coded ratings of NP treatment protocol adherence and competence ratings were completed from audio recordings, rated on a 1 (not at all) to 5 (completely) scale. Results: Twenty-five patients consented (ages 22-67 years; 76% female; 48% IBS-diarrhea predominant). There was high feasibility—adherence average = 4.1, NP competence average = 4.8, 72% treatment completion, 93% satisfaction scores ≥3. Treatment satisfaction was high (rated as 4/4 “very satisfied” by n = 9 and as 3/4 “mostly satisfied” by n = 5). There were improvements in clinical outcomes across treatment with large effects for IBS-symptom severity (−53%; Hedge's g = 1.0; 95% confidence interval [CI] = 0.5, 1.5) and IBS quality of life (+31%; Hedge's g = 0.8; 95% CI = 0.4, 1.2). Conclusions: NP-delivered exposure-CBT for IBS was initially feasible and acceptable with promising clinical improvements. Findings will inform a future NIH Stage 1B/ORBIT Phase IIB pilot randomized control trial.
AB - Background: Exposure-based cognitive–behavioral therapy (exposure-CBT) is efficacious for irritable bowel syndrome (IBS). However, few patients receive exposure-CBT due to a lack of behavioral health providers trained in brain–gut behavior therapies. Nurse practitioners (NPs) could fill a critical need for scalable delivery methods. In a pragmatic investigation of a 5-session NP-delivered exposure-CBT for adults with Rome IV-defined IBS, we evaluated treatment feasibility and acceptability and explored changes clinical outcomes. Methods: Exposure-CBT was delivered as part of routine care involving four sessions every other week and a 2-month booster session. Patients could electively participate in an observational study including pre-, mid-, and post-treatment surveys and a post-treatment qualitative interview. Independently coded ratings of NP treatment protocol adherence and competence ratings were completed from audio recordings, rated on a 1 (not at all) to 5 (completely) scale. Results: Twenty-five patients consented (ages 22-67 years; 76% female; 48% IBS-diarrhea predominant). There was high feasibility—adherence average = 4.1, NP competence average = 4.8, 72% treatment completion, 93% satisfaction scores ≥3. Treatment satisfaction was high (rated as 4/4 “very satisfied” by n = 9 and as 3/4 “mostly satisfied” by n = 5). There were improvements in clinical outcomes across treatment with large effects for IBS-symptom severity (−53%; Hedge's g = 1.0; 95% confidence interval [CI] = 0.5, 1.5) and IBS quality of life (+31%; Hedge's g = 0.8; 95% CI = 0.4, 1.2). Conclusions: NP-delivered exposure-CBT for IBS was initially feasible and acceptable with promising clinical improvements. Findings will inform a future NIH Stage 1B/ORBIT Phase IIB pilot randomized control trial.
KW - cognitive-behavioral therapy
KW - disorders of gut–brain interaction
KW - functional gastrointestinal disorders
KW - irritable bowel syndrome
KW - nurse practitioners
KW - nurses
UR - http://www.scopus.com/inward/record.url?scp=85146977605&partnerID=8YFLogxK
U2 - 10.1111/nmo.14526
DO - 10.1111/nmo.14526
M3 - Article
C2 - 36661110
AN - SCOPUS:85146977605
SN - 1350-1925
VL - 35
JO - Neurogastroenterology and Motility
JF - Neurogastroenterology and Motility
IS - 4
M1 - e14526
ER -