ECLIPSE Study 3: Preference domains for CRT implementation
Research type
Research Study
Full title
Enhancing Cognition and quality of LIfe in the early PSychosEs (ECLIPSE) - Study 3: Preference domains for CRT implementation
IRAS ID
185700
Contact name
Til Wykes
Contact email
Sponsor organisation
Kings College London
Duration of Study in the UK
0 years, 11 months, 30 days
Research summary
Research Summary
The ECLIPSE Programme aims to determine the best way of introducing cognitive remediation therapy (CRT) for psychosis into NHS early intervention services in order to optimise individual functional outcomes. Besides conducting a randomised controlled trial of CRT to evaluate cost-effectiveness of different implementation modes (WP3), the study also aims to examine which implementation modes are more acceptable to service users and staff, more feasible to implement and have economic benefits. In Work Package 1 data will be collected from: (i) service users and staff on treatment acceptability (Studies 1 and 2), (ii) service users and staff on preference domains for methods of treatment implementation (Study 3) and (iii) staff on organisational climate (Studies 4 and 5). The aim of the present study (WP1 - ECLIPSE Study 3) is to establish the key attributes and their levels for the modes of CRT delivery.
Focus groups with Early Intervention Service users (3 groups) or EIS staff (2 groups) will be convened and each will meet twice to discuss the domains of interventions most important to individuals. Each focus group will last up to 2 hours and will be facilitated by two trained researchers. The meetings will be recorded digitally and these ‘tapes’ transcribed. Approximately 18 to 24 service users (6 to 8 per group) and 12 to 16 (6 to 8 per group) staff in total will take part in the focus groups to develop the preference measure. The study will be carried out in Early Intervention Services. The outcome will be aspects of implementation and the levels of those domains that affect acceptability of CR implementation by service users and staff.Summary of Results
Cognitive remediation therapy has been shown to improve cognitive and functional recovery (Wykes et al, 2011), however less is known about which implementation modes are the most effective and acceptable. Hybrid methods of delivery, combining intensive, group and independent sessions, have proved popular with users and clinicians. The level of therapist support available appears to be a key to success. A strong therapeutic alliance is associated with increased cognition and function, as well as higher attendance and lower dropout rates.
To examine which methods of delivery were more acceptable to service users and staff in Early Intervention Services, we recruited 13 staff and 10 service users to take part in focus groups. The focus group facilitators were service-user researchers who transcribed the discussions and undertook a thematic analysis. One-to-one sessions were valued most, primarily because of higher levels of support, followed by group sessions, which were seen as a valuable opportunity for connection with peers. Independent delivery was thought unlikely to provide sufficient support and concerns were raised about accessibility for a computerised therapy. Regular, locally held, hourly sessions were preferred and both staff and service users saw the benefits of a flexible and personalised therapy, lasting for as long as needed. There were concerns from service users that the level of commitment expected would be burdensome and staff worried that this would have a negative impact on normal care and risk monitoring. Overall, however, CIRCuiTSTM was judged to provide a valuable opportunity for interaction, as well as improving cognitive deficits and associated everyday functioning.
REC name
Wales REC 6
REC reference
16/WA/0054
Date of REC Opinion
2 Feb 2016
REC opinion
Favourable Opinion