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Table 4 Experts' ratings: Choice of psychological therapy

From: Expert opinion on detecting and treating depression in palliative care: A Delphi study

Therapy
0 = not useful, 10 = very useful
Experts comments
Cognitive Behavioural Therapy (CBT)
Round 1: Median 9.5 (4-10); n = 12
Round 2: Median 9.0 (3-10); n = 12
-Choice depends on therapist's expertise and patient's preference!!
-Although psychotherapy at the end of life has some evidence base, there is less evidence for the effectiveness of individual therapies, so I feel unable to rate.
-Is there any evidence anywhere that any of the below are effective interventions, and do no harm. Too much unproven 'counselling' has caused harm over decades that I would not want my patients and their carers exposed to this
Problem-solving Therapy
Round 1: Median 10.0 (1-10); n = 11
Round 2: Median 8.0 (3-10); n = 12
-Probably better chance than CBT
-Too superficial
Presence of spiritual assistant upon request*
Round 2: Median 7.5 (1-10); n = 9
-We have to get better at specifically enquiring about the presence of a spiritual dimension to distress
-Not for all patients - just on request
Mindfulness-based therapy
Round 1: Median 7.0 (0-10); n = 9
Round 2: Median 7.0 (0-10); n = 10
-Useful for those who can learn it: interestingly, 'living in the moment' is a strategy spontaneously adopted by many patients who are coping well under difficult circumstances
-Not sure if there's any evidence
Guided imagery
Round 1: Median 6.0 (1-10); n = 11
Round 2: Median 7.0 (3-9); n = 9
-Temporarily relieves symptoms - but empowering and engenders hope
-Sometimes impossible for cultural or age resistance
Narrative Therapy
Round 1: Median 5.0 (0-8); n = 9
Round 2: Median 7.0 (0-9); n = 9
-I have experience: running well, easily accepted - especially by aged people - empowers the patient and increases his/her communication with loved ones
-Not sure if there's any evidence
Music Therapy*
Round 2: Median 6.0 (0-8); n = 9
-For those who cannot be reached by words
-More evidence for relief of physical symptoms than depression
Interpersonal Therapy
Round 1: Median 5.5 (0-10); n = 10
Round 2: Median 5.0 (0-8); n = 10
-Probably too time-consuming
Couple therapy
Round 1: Median 5.0 (1-8); n = 12
Round 2: Median 4.0 (0-8); n = 11
-Can be very useful
-Useful just if the family is reduced to two relevant people
  1. *Items suggested by experts in the first round and rated by the group in the second round