What do patients want from therapy? Understanding treatment goals of patients with long-term conditions referred for cognitive behavioural therapy in primary care

Abstract

Abstract Integrating cognitive behavioural therapy (CBT) into primary care for patients with long-terms conditions (LTCs) is a priority for the National Health Service (NHS) in the United Kingdom (UK). To inform delivery of cognitive behavioural interventions for this clinical population, the aim of this study was to evaluate the major treatment goal themes of patients with LTCs. A single group mixed-methods design was used to analys treatment goals and their association with patient characteristics. A total of n =222 patients (86 males; 132 females) who participated in a service development evaluation of the Accessible Depression and Anxiety Psychological Therapies for Individuals with Long-Term Conditions in Scotland (UK) were selected for inclusion if they reported at least one treatment goal at assessment. Data were drawn from routine outcome measures that recorded information in relation to client demographics, physical conditions, mental health, functioning and treatment goals. Participants freely reported up to three goals as part of assessment. Thematic analysis identified four major goal themes ranked in the following order of frequency: functioning, emotional health, condition management, and self-appraisal. Wanting to improve functioning was positively associated with age and depression, and negatively associated with anxiety. No other patient characteristics were associated with any of the major themes. Patients with LTCs referred to CBT in primary care can have wide-ranging goals that only partially correspond with their mental health status. Practitioners and service providers need to flexibly deliver CBT to enhance the individual relevance of therapy which is tailored to patient’s goals. Key learning aims (1) Treatment goals are fundamental to a better understanding of how best to assess and plan treatments that meet the needs of patients with long-term conditions. (2) We highlight the need to enhance practitioner competencies in aligning treatment with patient’s goals to ensure goal-based decision-making is achieved in practice. (3) Key areas of goal-oriented therapy for patients with long-term conditions include integrating aspects of wanting to improve functioning, emotional health, condition management, and self-appraisal. These aspects should represent primary outcomes of treatment.