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 |