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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: [email protected]
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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 

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