Tracking progress via clinical feedback systems in treatment of substance use disorders: a qualitative study exploring patients' response processes.

Background: In recent decades, there has been a shift in many substance use disorder (SUD) treatment settings toward routine outcome monitoring via clinical feedback systems (ROM/CFS). This move toward frequent measurement throughout the treatment course raises new questions about which variables should be measured in the evolving treatment process. In particular, there seems to be a lack of knowledge concerning self-report measures' ability to capture patients' subjective experiences relevant for treatment outcome and process. This qualitative study explored patients' perspectives and reasoning processes to investigate how feedback systems can be adapted to track progress in the treatment of SUDs.

Methods: Patients (N = 13) in specialized SUD treatment were interviewed while they responded to items from a feedback system used for routine outcome monitoring in that treatment setting. The approach to data collection was inspired by cognitive interviewing and the analysis was based on a descriptive and interpretative approach.

Results: The findings provide support for monitoring of several outcome variables, such as behavioral and experiential symptoms, as well as variables relevant to everyday functioning. However, we also found that several aspects related to the subjective experience of being in an ongoing process of change provided important context for the various outcome variables during treatment. The analysis resulted in three themes reflecting this duality and issues that appeared important to consider together when adapting clinical feedback systems to longitudinal monitoring in SUD treatment: 1) The necessity of capturing both preliminary outcomes and the attitude toward the ongoing process of change; 2) The necessity of capturing both the passive and the active role of the patient; and 3) The necessity of capturing both objective and subjective change constructs. Related to each theme we describe the participants' different interpretations of specific items and how different item characteristics facilitated meaningful measurement or not.

Conclusions: The findings expand the knowledge base and strengthen the qualitative foundation for longitudinal monitoring of SUDs and have implications for how feedback measures should be designed. The study also provides knowledge about the process of change and highlights patient experiences that are worth paying attention to when tracking progress in treatment of SUDs.