Hostname: page-component-5c6d5d7d68-thh2z Total loading time: 0 Render date: 2024-08-15T21:26:45.286Z Has data issue: false hasContentIssue false
  • English
  • Français

Identifying critical psychotherapy targets in serious cardiac conditions: The importance of addressing coping with symptoms, healthcare navigation, and social support

Published online by Cambridge University Press:  31 January 2019

David B. Bekelman ,
Christopher E. Knoepke  and
Carolyn Turvey
David B. Bekelman*
Affiliation:
Department of Medicine, Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
Christopher E. Knoepke
Affiliation:
Adult & Child Consortium for Outcome Research & Delivery Science, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
Carolyn Turvey
Affiliation:
University of Iowa Carver College of Medicine and Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation Center, Iowa City, IA
*
Author for correspondence: David B. Bekelman, MD, MPH, Department of Medicine, Eastern Colorado Healthcare System, Department of Veterans Affairs, 1055 Clermont Street, A3-151, Denver, CO 80220. E-mail: david.bekelman@ucdenver.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy.

Method

During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits.

Result

A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%).

Significance of results

Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.

Keywords

PsychotherapyCase managementHeart failureSocial workDepression
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 5 , October 2019 , pp. 531 - 535
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aburizik, A, Dindo, L, Kaboli, P, et al. (2013) A pilot randomized controlled trial of a depression and disease management program delivered by phone. Journal of Affective Disorders 151(2), 769–774.Google Scholar
Areán, PA, Raue, PJ, McCulloch, C, et al. (2015) Effects of problem-solving therapy and clinical case management on disability in low-income older adults. The American Journal of Geriatric Psychiatry 23(12), 1307–1314.Google Scholar
Bekelman, DB, Allen, LA, Peterson, J, et al. (2016) Rationale and study design of a patient-centered intervention to improve health status in chronic heart failure: The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) randomized trial. Contemporary Clinical Trials 51, 1–7.Google Scholar
Bekelman, DB, Allen, LA, McBryde, CF, et al. (2018). Effect of a collaborative care intervention vs usual care on health status of patients with chronic heart failure: The CASA Randomized Clinical Trial. JAMA Internal Medicine 178(4), 511–519.Google Scholar
Bekelman, DB, Havranek, EP, Becker, DM, et al. (2007) Symptoms, depression, and quality of life in patients with heart failure. Journal of Cardiac Failure 13(8), 643–648.Google Scholar
Bekelman, DB, Hooker, SNowels, CT, et al. (2014) Feasibility and acceptability of a collaborative care intervention to improve symptoms and quality of life in chronic heart failure: Mixed methods pilot trial. Journal of Palliative Medicine 17(2), 145–151.Google Scholar
Bekelman, DB, Nowels, CT, Retrum, JH, et al. (2011) Giving voice to patients' and family caregivers' needs in chronic heart failure: Implications for palliative care programs. Journal of Palliative Medicine 14(12), 1317–1324.Google Scholar
Berkman, B (1996) The emerging health care world: Implications for social work practice and education. Social Work 41(5), 541–551.Google Scholar
Berkman, LF, Blumenthal, J, Burg, M, et al. (2003) Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Journal of the American Medical Association 289(23), 3106–3116.Google Scholar
Frasure-Smith, N, Lespérance, F, Prince, RH, et al. (1997) Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. The Lancet 350(9076), 473–479.Google Scholar
Freedland, KE, Carney, RM, Rich, MW, et al. (2015) Cognitive behavior therapy for depression and self-care in heart failure patients: A randomized clinical trial. JAMA Internal Medicine 175(11), 1773–1782.Google Scholar
Gum, AM, Areán, PA, and Bostrom, A (2007) Low-income depressed older adults with psychiatric comorbidity: Secondary analyses of response to psychotherapy and case management. International Journal of Geriatric Psychiatry 22(2), 124–130.Google Scholar
Hsieh, H-F and Shannon, SE (2005) Three approaches to qualitative content analysis. Qualitative Health Research 15(9), 1277–1288.Google Scholar
Lespérance, F, Frasure-Smith, N, Koszycki, D, et al. (2007) Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association 297(4), 367–379.Google Scholar
Rutledge, T, Reis, VA, Linke, SE, et al. (2006) Depression in heart failure: A meta-analytic review of the prevalence, intervention effects, and associations with clinical outcomes. Journal of the American College of Cardiology 48(8), 1527–1537.Google Scholar
Turvey, CL and Klein, DM (2008) Remission from depression comorbid with chronic illness and physical impairment. American Journal of Psychiatry 165(5), 569–574.Google Scholar
Walke, LM, Gallo, WT, Tinetti, ME, et al. (2004) The burden of symptoms among community-dwelling older persons with advanced chronic disease. Archives of Internal Medicine 164(21), 2321–2324.Google Scholar