Methodology of research

Research into ethical issues is a relatively new concept in medical research. This research enables us to gather evidence relating to ethical dilemmas in clinical practice in order to establish an ethical basis for treatments

The aim of the studies was to understand the treatment decision-making process in anorexia nervosa and the capacity to consent to treatment, including whether it is justifiable to override the treatment refusal of a patient with anorexia nervosa.

A series of four different research studies were conducted over a period of several years. Due to resource issues, we decided only to interview females, but we are conscious that there are many males with anorexia nervosa who may have different experiences.

Schematic Diagram of the Research Enterprise

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To find out why we also had a workshops project, click here

To find out what the main findings of our research were, click here.

 

In the preliminary study, the methodology of the research and the ethical analysis of the results were developed. We interviewed a total of 10 young women aged 13 to 21 years who were having or recently had anorexia nervosa, and their parents (mostly mothers). The interviews were taped, transcribed, and then analysed, looking for themes. This research identified a range of factors that are involved in making treatment decisions in anorexia nervosa, and led to us obtaining funding for three further studies.

In the longitudinal interview study, five of the young women who had taken part in the preliminary study agreed to be interviewed yearly up to a period of 5 years after their original interviews. This was originally designed to enable us to see how their views about decision-making change over time. What we found was that their views about decision-making were remarkable consistent over time. However, their attitudes to themselves and their disorder showed considerable change.

In the large interview study, we continued to develop our exploration of how people make treatment decisions and how this can be affected by anorexia nervosa and treatment experiences. We interviewed a total of 29 young women aged 15 to 25 years who were having or had recently had anorexia nervosa, and many of their parents. This research confirmed many of the findings of the preliminary study. It also taught us more about the complexities of making treatment decisions when a person has anorexia nervosa. The treatment experience and relationships with family and professionals emerged as very important factors in whether, and how, people are able to make decisions to accept treatment.

In the questionnaire study of attitudes, we sent out questionnaires in the post to senior psychiatrists in the South East of England (general adult psychiatrists and child and adolescent psychiatrists) and across the United Kingdom (members of the Royal College of Psychiatrists Special Interest Group in Eating Disorders). A total of 686 psychiatrists returned questionnaires. This research showed us that senior psychiatrists in general do support the use of the Mental Health Act for treating anorexia nervosa, with particularly strong support for the use of the Mental Health Act of compulsory re-feeding of people who have anorexia nervosa (compulsory re-feeding would normally only apply to people who are at extremely low weights and at considerable physical risk). There was a range of attitudes amongst psychiatrists about whether people who have anorexia nervosa choose or are able to control their weight loss behaviours. We found that eating disorder specialists were more likely to think that even people with mild anorexia nervosa do not choose or cannot control their weight loss behaviours. They were also more likely to think that people with anorexia nervosa may be affected in their ability to make treatment decisions.

We will not be describing the questionnaire study further in this report, which will concentrate on our findings in the interview studies and feedback from the workshops about the interview studies. To find out more about the results of the questionnaire study, look up our article about it in the electronic free access journal, Child and Adolescent Psychiatry and Mental Health: http://www.capmh.com/content/2/1/40