CADENCE Study version 1
Research type
Research Study
Full title
A feasibility study and pilot RCT to establish methods for assessing the acceptability, and clinical and cost-effectiveness of enhanced psychological care (EPC) in cardiac rehabilitation services for patients with new onset depression compared with treatment as usual: CADENCE Study
IRAS ID
154452
Contact name
John Campbell
Contact email
Sponsor organisation
Royal Devon & Exeter NHS Foundation Trust
Duration of Study in the UK
2 years, 1 months, 2 days
Research summary
The NHS offers cardiac rehabilitation (CR) to patients who experience an acute cardiac event (e.g. heart attack, heart surgery). On referral to a comprehensive CR programme, patients are routinely assessed by a nurse and around 17% report depressive symptoms. Although CR programmes should provide a range of support, only 10% of teams offer expert psychological care. People with depressive symptoms are normally advised to seek help from their general practitioner. NHS guidance recommends that initial treatments for depression should be low-intensity talking therapies delivered by community-based psychological services. Patients should only receive more intensive treatment (e.g. drugs) when their symptoms fail to respond to low-intensity therapy or if symptoms are so serious they warrant more immediate high-intensity response. It is also known that older people with depression are less likely than younger people to seek help from their general practitioner.
There is a clear need to train CR staff on how to improve referrals to existing community psychological services through implementing NHS good practice guidance for patients with depressive symptoms. However, given the reluctance of depressed older people to seek help, we believe that training CR nurses to deliver a low-intensity behavioural activation (BA) therapy as part of the CR care pathway may directly support patients, and might remove the need for onward referral. This research will establish methods for assessing the acceptability and effectiveness of enhanced psychological care (EPC) delivered by CR nurses compared with usual CR care. The EPC intervention has two components: collaborative mental health care-coordination and referral, and BA therapy offered within a comprehensive CR programme. On referral to a CR programme, patients with depressive symptoms will be offered study participation. A two phase study is planned including a feasibility study followed by a pilot trial and interview study.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
14/SW/0139
Date of REC Opinion
23 Jul 2014
REC opinion
Further Information Favourable Opinion