A SYSTEMATIC REVIEW OF THE USE OF BURDEN OF TREATMENT THEORY

Problem

Burden of Treatment Theory (BOTT) provides a framework to illustrate and explain how interactions between patients, their healthcare systems and their support networks can affect and exacerbate patient ability to manage their illness. BOTT outlines how patient capacity is influenced by structural and contextual factors that extend beyond the individual and highlights the importance of understanding these interactions to mitigate treatment burden. We aimed to characterise applications of BOTT in research in order to explore its contribution to the understanding of treatment burden and capacity issues for self-management.

Approach

A qualitative systematic review of literature was carried out on five electronic databases for original research articles, protocols, or preprints published in the English language which cited the key paper presenting BOTT. Papers which used and engaged with BOTT, for example in their approach to data analysis, data collection, to aid in development of interventions, or to thematise or characterise data were included. The search was undertaken in December 2021 and updated in June 2022. DistillerSR software was used to carry out screening and data extraction processes, with 20% of papers double-coded. Quality appraisal using CASP checklists and the Mixed Methods Review checklist was carried out on studies with empirical data.

Findings

Searches yielded 613 citations. After removal of 310 duplicates, 303 papers were screened as titles and abstracts, with 89 excluded due to not meeting inclusion criteria. 214 papers then underwent full-text screening and 185 were excluded. In total, 29 papers met inclusion criteria for this review. Whilst not scored, all included studies assessed via quality appraisal checklists were of high quality. BOTT has been applied across a diverse range of settings and research types, with the most common use being to aid in data analysis or data collection for qualitative studies seeking to characterise treatment burden. Another common use was to aid intervention development in research focused on workload alleviation in a diverse range of settings. The singular paper with a non-clinical setting focused on the feasibility of a web-based domestic violence intervention. The constructs of BOTT appear to be stable across different settings, and researcher commentary on theory utility was generally positive. Two papers adapted and extended BOTT to further suit the context of their research focus. Discussion of BOTT constructs revealed appropriate understanding and a high level of critical engagement.

Consequences

BOTT provides a useful conceptual, analytical and sensitising lens in studies focusing on both the characterisation and the alleviation of treatment burden through healthcare interventions, and the constructs discussed are stable and applicable to a wide range of healthcare settings. Future research studies could further examine the utility of BOTT by using it in contexts that would potentially require more adaptation and critical assessment of the theory.