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How, when and where could affect outcome of psychological treatment

Meeting patients’ preferences for the time and place of their psychological treatment may affect their perception of treatment outcome, a cross-sectional survey by researchers from the Royal College of Psychiatrists and Imperial College London involving 14,587 respondents suggests.

The study, published in the open access journal BMC Psychiatry, examined treatment preferences of patients involved in the National Audit of Psychological Therapies according to five aspects: venue, time of day, gender of therapist, language that the treatment was delivered in, and therapy type. For each of these features, patients were asked to rate whether or not they had a strong preference and if they were given enough choice. They were also asked to evaluate their satisfaction with treatment outcome using a five-point scale.

A total of 86% of patients expressed a preference for at least one of the five aspects – time of day and location being the two most popular preferences. Out of those patients, 36.7% said that at least one of their preferences had not been met. Lead researcher, Mike Crawford, said: “People who have preferences for how, when and where psychological treatment is delivered that are not met, are less likely to report that they were helped by the treatment.”

The researchers analyzed data from anonymous survey results of patients who received treatment from 184 NHS services in England and Wales in 2012-13. They wanted to determine to what degree patients express preferences regarding certain aspects of their psychological treatment, whether they feel that these preferences are met and how that impacts their perception of the treatment outcome.

The study relied on quantitative survey data based on patient recall rather than qualitative interviews and evaluated perception of outcome, rather than evaluating the outcome itself. Thus, it could not explore whether patients whose preferences were not met went on to benefit less from treatment, or whether the perception of poor outcome was attributed to unmet preferences retrospectively when patients completed the survey.

Providers of psychological treatment in the UK are encouraged to offer patients choices about their treatments, despite limited information on people’s preferences and a lack of evidence of how meeting these preferences affects therapy outcome. The researchers suggest that their findings highlight the importance of assessing and meeting patient preferences and offering patients adequate choice.

Mike Crawford said: “Psychological treatment services need to recognize that people often have preferences for how, when and where treatment is delivered. Treatment may be more effective when patient preferences are met by the service.”