Using a patient-generated mental-health measure ‘PSYCHLOPS’ to explore problems in patients with coronary heart disease

Lawton, Rebecca; Seed, Paul; Kordowicz, Maria; Schofield, Peter; Tylee, André; Ashworth, Mark

doi:10.3399/bjgp14x680137

Cited by 5 publications

(9 citation statements)

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“…They (Psychological Outcome Profiles Questionnaire and Rapid Estimate of Adult Literacy in Medicine) were analysed separately and led to publications, which are listed in the acknowledgments. 197,198 The third (Guy's Hospital Questionnaire) was suggested by the cardiologist on the team but was abandoned because it was too difficult to administer over the telephone. Original data sets downloaded from MACRO by the Data Manager (Christopher Rowson) and emailed as a .csv file Rachel Phillips was responsible for receiving all extractions up to and including the 24-month data RP also wrote the instructions for cleaning the data sets and data checking processes…”

Section: Discussionmentioning

confidence: 99%

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Tylee

Barley

Walters

et al. 2016

Programme Grants Appl Res

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BackgroundDepression is common in patients with coronary heart disease (CHD) but the relationship is uncertain. In the UK, general practitioners (GPs) have been remunerated for finding depression in CHD patients; however, it is unclear how to manage these patients.ObjectivesOur aim was to explore the relationship between CHD and depression in a GP population and to develop nurse-led personalised care (PC) for patients with CHD and depression.DesignThe UPBEAT-UK study consisted of four related studies. A cohort study of patients from CHD registers to explore the relationship between CHD and depression. A metasynthesis of relevant literature and two qualitative studies [patients’ perspectives and GP/practice nurse (PN) views on management of CHD and depression] helped develop an intervention. A pilot randomised controlled trial (RCT) of PC was conducted.SettingThirty-three GP surgeries in south London.ParticipantsAdult patients on GP CHD registers.InterventionsFrom the qualitative studies, we developed nurse-led PC, combining case management and self-management theory. Following biopsychosocial assessment, a PC plan was devised for each patient with chest pain and depressive symptoms. Nurses helped patients address their most important related problems. Use of existing resources was promoted. Nurse time was conserved through telephone follow-up.Main outcome measuresThe main outcome of the pilot study of our newly developed PC for people with depression and CHD was to assess the acceptability and feasibility of the intervention and to decide on the best outcome measures. Depression, measured by the Hospital Anxiety and Depression Scale – depression subscale, and chest pain, measured by the Rose angina questionnaire, were the main outcome measures for the feasibility and cohort studies. Cardiac outcomes in the cohort study included: attendance at rapid access chest pain clinics, stent insertion, bypass graft surgery, myocardial infarction and cardiovascular death. Service use and costs were measured and linked to quality-adjusted life-years (QALYs). Data for the pilot RCT were obtained by research assistants from patient interviews at baseline, 1, 6 and 12 months for the pilot RCT and at baseline and 6-monthly interviews for up to 36 months for the cohort study, using standard questionnaires.ResultsPersonalised care was acceptable to patients and proved feasible. The reporting of chest pain in the intervention group was half that of the control group at 6 months, and this reduction was maintained at 1 year. There was also a small improvement in self-efficacy measures in the intervention group at 12 months. Anxiety was more prevalent than depression in our CHD cohort over the 3 years. Nearly half of the cohort complained of chest pain at outset, with two-thirds of these being suggestive of angina. Baseline exertional chest pain (suggestive of angina), anxiety and depression were independent predictors of adverse cardiac outcome. Psychosocial factors predicted the continued reporting of exertional chest pain across the 3 years of follow-up. Costs were slightly lower for the PC group but QALYs were also lower. Neither difference was statistically significant.ConclusionsChest pain, anxiety, depression and social problems are common in patients on CHD registers in primary care and predict adverse cardiac outcomes. Together they pose a complex management problem for GPs and PNs. Our pilot trial of PC suggests a promising approach for treatment of these patients. Generalisation is limited because of the selection bias in recruitment of the practices and the subsequent participation rate of the CHD register patients, and the fact that the research took place in south London boroughs. Future work should explicitly explore methods for effective implementation of the intervention, including staff training needs and changes to practice.Trial registrationCurrent Controlled Trials ISRCTN21615909.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 8. See the NIHR Journals Library website for further project information.

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Section: Discussionmentioning

confidence: 99%

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Tylee

Barley

Walters

et al. 2016

Programme Grants Appl Res

Self Cite

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“…The same seven high-level problem themes were used in a subsequent publication, though were further defined into 61 subthemes for both the problem and the functioning domains of the PSYCHLOPS (Ashworth et al, 2007). Lawton et al (2014) coded three problem and functioning themes (physical, psychological, and social), further stratified into nine subthemes (e.g., social work, social money). Evidence from one of these studies (Ashworth et al, 2007) suggests that the PSYCHLOPS reported problems may be more comprehensive than those captured using a quantitative, fully structured nomothetic instrument.…”

Section: Consideration Of Culture and Individual Experience Is Atmentioning

confidence: 99%

“…Categorisations for PSYCHLOPS have been used previously in three studies from the UK (Ashworth et al, 2007;Lawton et al, 2014;Robinson et al, 2007), but due to the geographical and cultural diversity of the populations under study, researchers used a datadriven approach. Two researchers (MHS and EvtH) independently coded the responses given to the qualitative items of PSYCHLOPS to identify themes in a two-step process.…”

Section: Data Codingmentioning

confidence: 99%

“…Three previous studies, all from the UK, have explored the qualitative results of the PSYCHLOPS questionnaire (Ashworth et al., 2007; Lawton et al., 2014; Robinson, Ashworth, Shepherd, & Evans, 2007). Coding of responses differed across these studies.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using a person-generated mental health outcome measure in large clinical trials in Kenya and Pakistan: Self-perceived problem responses in diverse communities

Shehadeh

Hof

Schafer

et al. 2019

Transcult Psychiatry

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Health care should be informed by the physical, socioeconomic, mental, and emotional well-being of the person, and account for social circumstances and culture. Patient-generated outcome measures can contribute positively to mental health research in culturally diverse populations. In this study, we analysed qualitative responses to the Psychological Outcome Profiles (PSYCHLOPS) Questionnaire—a patient-generated outcome measure based on open-ended questions, and compared the qualitative responses gathered to conventional, nomothetic measures used alongside the PSYCHLOPS in two studies. Data were collected as part of outcome research on a psychological intervention in Pakistan ( N = 346) and Kenya ( N = 521). Two researchers coded the qualitative responses to the PSYCHLOPS and identified overarching themes. We compared the overarching themes identified to the items in the conventional, nomothetic outcome measures to investigate conceptual equivalence. Using the PSYCHLOPS, the most frequently reported problems in Kenya were financial constraints, poor health, and unemployment. In Pakistan, the most frequent problems were poor health and emotional problems. Most of the person-generated problem concepts were covered also in nomothetic measures that were part of the same study. However, there was no item equivalence in the nomothetic measures for the most frequent PSYCHLOPS problem cited in both countries. Response bias and measurement bias may not be excluded. More research on the use of PSYCHLOPS alongside conventional outcome measures is needed to further explore the extent to which it may bring added value. Use of a PSYCHLOPS semistructured interview schedule and efforts to minimise response biases should be considered.

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Patient-Centered Assessment in Psychotherapy: A Review of Individualized Tools

Sales

Alves

2016

Clin Psychol Sci Pract

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There has been an increasing interest in patient‐centered assessment of psychological treatments. This article reviews the existing patient‐generated measures (PGMs) that have been used by clinicians and psychotherapy researchers to collect evaluation data from the patient perspective. A systematic review of literature was performed to identify PGMs in empirical studies between 1990 and 2014. Twenty tools were identified, of which three were designed to assess the outcome and 17 to assess the process of therapy. The characteristics of each are described and discussed, including psychometric data and evidence of clinical utility. This review helps professionals and researchers to implement the recommendation of health policies that advocate the importance of patient‐centered care.

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Using a patient-generated mental-health measure ‘PSYCHLOPS’ to explore problems in patients with coronary heart disease

Abstract: BackgroundPatients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality.

Cited by 5 publications

References 21 publications

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

UPBEAT-UK: a programme of research into the relationship between coronary heart disease and depression in primary care patients

Using a person-generated mental health outcome measure in large clinical trials in Kenya and Pakistan: Self-perceived problem responses in diverse communities

Patient-Centered Assessment in Psychotherapy: A Review of Individualized Tools

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