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Harrigan M, Georgiopoulos AM, Quittner AL, Smith B, Douglas TA. Psychosocial and mental health in cystic fibrosis in the modern era of care: time to evolve. BMJ Open Respir Res 2025; 12:e002606. [PMID: 39929550 PMCID: PMC11815457 DOI: 10.1136/bmjresp-2024-002606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 12/17/2024] [Indexed: 02/14/2025] Open
Abstract
Cystic fibrosis (CF) treatment has revolutionised care over the past three decades with major advances in survival. Despite these advances, CF continues to create psychological and social challenges for people with CF (PWCF) throughout their life and is associated with worse health outcomes and higher healthcare costs. Anxiety and depression screening and management protocols are widely implemented within CF care; however, a much broader scope of psychosocial challenges exist which lack a standardised screening and management approach. The advent of CF transmembrane conductance regulator modulator therapies is transforming the psychosocial landscape for PWCF with new challenges and evolving psychosocial needs. What it means to have CF, the expectations, hopes and stressors are rapidly changing, and psychosocial care must keep pace if health outcomes are to be fully optimised. A symposium of international CF and psychosocial experts was convened in November 2022 to explore current and emerging issues in psychosocial health and identify opportunities and approaches to optimise psychosocial care. This state-of-the-art review summarises key symposium proceedings and highlights priorities for clinical practice and research in psychosocial health across the lifespan among PWCF. It also summarises state-of-the-art initiatives for screening and intervention to optimise CF psychosocial healthcare and patient outcomes.
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Affiliation(s)
- Maggie Harrigan
- The University of Western Australia Medical School, Perth, Western Australia, Australia
- Institute for Respiratory Health, Perth, Western Australia, Australia
- Cystic Fibrosis Western Australia, Perth, Western Australia, Australia
| | - Anna M Georgiopoulos
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexandra L Quittner
- Joe DiMaggio Cystic Fibrosis, Pulmonary and Sleep Center, Hollywood, Florida, USA
| | - Beth Smith
- Division of Child and Adolescent Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tonia A Douglas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Faculty of Medicine, Clinical Unit, The University of Queensland, Brisbane, Queensland, Australia
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Brown RF, Close CT, Mailes MG, Gonzalez LJ, Goetz DM, Filigno SS, Preslar R, Tran QT, Hempstead SE, Lomas P, Brown AW, Flume PA. Cystic fibrosis foundation position paper: Redefining the cystic fibrosis care team. J Cyst Fibros 2024; 23:1045-1054. [PMID: 39327194 DOI: 10.1016/j.jcf.2024.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 09/28/2024]
Abstract
Interdisciplinary teams care for people with cystic fibrosis (pwCF) at specialized treatment centers. These teams have laid the foundation for the cystic fibrosis (CF) care model responsible for gains in health outcomes and quality of life within the CF community. However, the landscape of CF care is transforming, invigorated by new technologies, accessibility of cystic fibrosis transmembrane conductance regulator (CFTR) therapies, and increased utilization of telemedicine. In light of these advances, it is appropriate to re-evaluate the CF care team structure. This position paper offers guidance for the structure of a CF care center designed to meet the evolving needs of the CF community. Fundamental to the proposed center structure is recognition of pwCF and their families as integral members of their care teams, underpinning the necessity for shared decision making, awareness of social determinants of health, and active partnership between all healthcare professionals involved in the care of pwCF.
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Affiliation(s)
- Rebekah F Brown
- Department of Pediatrics, Division of Allergy, Immunology and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Charlotte T Close
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Molly G Mailes
- Division of Pulmonology and Sleep Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Luis J Gonzalez
- Departments of Outpatient Pharmacy and Internal Medicine, University of New Mexico Hospitals, Albuquerque, NM, USA
| | - Danielle M Goetz
- Division of Pediatric Pulmonology & Sleep Medicine, Department of Pediatrics, University at Buffalo School of Medicine, Buffalo, NY, USA
| | - Stephanie S Filigno
- Divisions of Behavioral Medicine and Clinical Psychology and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Rebecca Preslar
- Community Advisor to the Cystic Fibrosis Foundation, Bethesda, MD, USA
| | | | | | - Paula Lomas
- Cystic Fibrosis Foundation, Bethesda, MD, USA
| | - A Whitney Brown
- Cystic Fibrosis Foundation, Bethesda, MD, USA; Advanced Lung Disease and Transplant Program, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Patrick A Flume
- Departments of Medicine and Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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Campagna G, Tagliati C, Giuseppetti GM, Ripani P. Treatment of Psychological Symptoms in Patients with Cystic Fibrosis. J Clin Med 2024; 13:5806. [PMID: 39407865 PMCID: PMC11476740 DOI: 10.3390/jcm13195806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 10/20/2024] Open
Abstract
The aim of this article is to identify and illustrate the most used psychological techniques in the field of cystic fibrosis (CF) and to help clinicians choose the most appropriate strategy among various possibilities. The disease and its medical treatments can be difficult to tolerate and can cause anxiety about health status or feelings of hopelessness and stress. The prevalence of depression and anxiety is 2.3 times higher in adults with CF than in community samples. A strong correlation has been identified between elevated psychological distress and unfavorable health outcomes, including, among others, impaired lung function, reduced BMI, an increased incidence of pulmonary exacerbations, and an elevated risk of transplantation. The use of psychological interventions is useful in addressing these common distresses in CF patients. Aware of the necessity of identifying efficacious interventions for all levels of depression and anxiety in CF patients, this study presents an overview of the research on psychological interventions for patients with CF, in order to complement the treatments suggested by the international guidelines on mental health in CF cases. In fact, the aim of this study is to conduct a review and quantitative synthesis of the psychological intervention techniques that are currently available for individuals with CF.
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Affiliation(s)
- Giovanna Campagna
- UOSD CRR Fibrosi Cistica Ospedale “San Liberatore”, Dipartimento Materno Infantile, ASL Teramo, 64032 Atri, Italy; (G.C.); (P.R.)
| | - Corrado Tagliati
- AST Ancona, Ospedale di Comunità, Via Marconi 1, 60040 Sassoferrato, Italy
| | | | - Pietro Ripani
- UOSD CRR Fibrosi Cistica Ospedale “San Liberatore”, Dipartimento Materno Infantile, ASL Teramo, 64032 Atri, Italy; (G.C.); (P.R.)
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Verkleij M, Georgiopoulos AM, Barendrecht H, Friedman D. Pilot of a therapist-guided digital mental health intervention (eHealth CF-CBT) for adults with cystic fibrosis. Pediatr Pulmonol 2023. [PMID: 37144856 DOI: 10.1002/ppul.26438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND eHealth CF-CBT is the first digital mental health intervention for depression/anxiety in adults with cystic fibrosis (awCF); an 8-session therapist-guided internet-delivered program that was developed in English and Dutch with stakeholder input and evaluation indicating high acceptability and usability. METHODS Dutch eHealth CF-CBT was piloted in awCF with mild-moderate symptoms of depression and/or anxiety. Feasibility, usability, acceptability, and preliminary efficacy were assessed, measuring pre-post changes in depression (PHQ-9), anxiety (GAD-7), perceived stress (PSS), and health-related quality of life (CFQ-R). RESULTS All participants (n = 10, seven female, mean age 29 [range 21-43], mean FEV1 71%pred [range 31-115]) completed all sessions. Patient-rated feasibility, usability, and acceptability of eHealth CF-CBT were positive on validated scales, as were qualitative assessments of content and format. GAD-7 improved in 90% of participants; in 50% by ≥the minimally important difference (MID) of four points. PHQ-9 improved in 90%; 40% by ≥the MID of 5. PSS improved in 80%. CFQ-R improved in the domain health perceptions (70%). CONCLUSIONS eHealth CF-CBT demonstrated feasibility, usability, acceptability, and promising preliminary efficacy in this pilot trial with Dutch awCF with mild to moderate symptoms of depression and anxiety.
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Affiliation(s)
- Marieke Verkleij
- Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Digital health, Amsterdam, The Netherlands
| | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Heleen Barendrecht
- Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands
| | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Friedman D, Smith BA, Bruce A, Schwartz CE, Lee H, Pinsky H, Gootkind E, Hardcastle M, Shea N, Roach CM, Miller C, Polineni D, Salathe M, Quittner AL, Georgiopoulos AM. Feasibility and acceptability of a CF-specific cognitive-behavioral preventive intervention for adults integrated into team-based care. Pediatr Pulmonol 2022; 57:2781-2790. [PMID: 35931665 DOI: 10.1002/ppul.26101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 07/09/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND A cystic fibrosis (CF)-specific cognitive-behavioral therapy intervention (CF-CBT) was developed in partnership with the CF community to advance preventive mental health care. Multidisciplinary providers across three centers were trained to deliver CF-CBT for this pilot assessing feasibility/acceptability and preliminary effectiveness of an integrated model of care. METHODS The 8-session CF-CBT was delivered to 14 adults with mild depression and/or anxiety symptoms in-person and via audio telehealth. Assessment of attrition, engagement, homework completion, treatment satisfaction, and treatment fidelity informed feasibility/acceptability assessment. Mental health outcomes included depression, anxiety, quality of life (Cystic Fibrosis Questionnaire-Revised [CFQ-R), perceived stress and coping. Preliminary effectiveness was evaluated with Cohen's d metric of effect sizes (ES) of pre-post mean change scores. RESULTS A total of 108 sessions were conducted; 13 adults completed the intervention; 1 discontinued early. Engagement, homework completion, and treatment acceptability were highly rated (mean = 30; SD = 2, range: 27-32 on a 32-point scale). Fidelity scores ranged from 85.7% to 93.6%. Large ES changes reflected improvements in depressive symptoms (-0.83), CFQ-R (Vitality scale: 1.11), and Relaxation Skills (0.93); moderate ES for CFQ-R Role Functioning (0.63), Awareness of Tension (0.62), Coping Confidence (0.70) and CF-specific Coping (0.55); and small ES for anxiety symptoms (-0.22), perceived stress (-0.25), Behavioral Activation (0.29), and several CFQ-R domains, including Emotional Functioning (0.29). Two CFQ-R subscales decreased (Body Image, Eating Concerns). CONCLUSIONS Results indicated feasibility and acceptability of CF-CBT and its integration into team-based CF care with promising effectiveness, especially for depression. A multicenter randomized controlled trial of CF-CBT will further examine effectiveness of a CF-specific integrated care model.
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Affiliation(s)
- Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Beth A Smith
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York, USA.,Department of Psychiatry, University of Buffalo School of Medicine, Buffalo, New York, USA
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Carolyn E Schwartz
- DeltaQuest Foundation, Inc., Concord, Massachusetts, USA.,Department of Medicine and Orthopaedic Surgery, Tufts University School Of Medicine, Boston, Massachusetts, USA
| | - Hang Lee
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hanna Pinsky
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Gootkind
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Margot Hardcastle
- Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicole Shea
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York, USA
| | - Christine M Roach
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York, USA
| | - Caitlin Miller
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, New York, USA
| | - Deepika Polineni
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthias Salathe
- Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Anna M Georgiopoulos
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Friedman D, Kaskas MM, Quittner AL, Smith BA, Georgiopoulos AM. Patient engagement in the development of CF-CBT: A cystic fibrosis-specific cognitive-behavioral intervention for adults. Front Psychol 2022; 13:937189. [PMID: 36275208 PMCID: PMC9585970 DOI: 10.3389/fpsyg.2022.937189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/08/2022] [Indexed: 08/27/2023] Open
Abstract
Individuals with cystic fibrosis (CF) are at high risk for depression and anxiety, with negative consequences for health and quality of life. Cystic Fibrosis Foundation/European Cystic Fibrosis Society guidelines recommend routine screening, treatment, and preventative efforts. Cognitive-behavioral therapy (CBT) has a large evidence-base for depression/anxiety prevention and treatment. However, traditional CBT protocols require adaptation to address the emotional challenges of coping with CF, stressors related to disease management, and barriers to access to care. The goal of this study was to partner with the CF community to develop an innovative CBT-based intervention for the prevention and treatment of depression and anxiety tailored to CF-specific needs. In-depth feedback was collected via audio-recorded telephone interviews with 16 adults with CF from 3 U.S. CF centers, with purposive sampling across gender, age, ethnicity, and disease severity. A semi-structured interview guide elicited discussion of patient experiences of coping with CF, and perspectives on the acceptability of the content, structure, and delivery model of the proposed intervention. Qualitative analysis utilized a content analytic approach. Participants ranged from 21 to 53 years (M = 35); eight were female; three were Hispanic. Patient-reported most recent FEV1, a measure of lung function based on forced expiratory volume in in one second, ranged from 25 to 113% predicted (M = 72). One participant was post-double lung transplant. Qualitative interviews were analyzed thematically revealing core themes related to the experience of coping with CF. The most frequently cited CF-related stressors were Treatment Burden, Illness Uncertainty, and Financial/Insurance Stress. Participants talked about the interaction of physical symptoms and emotional distress in their daily lives, a topic not typically discussed in routine CF care. Resilience was also a major theme with participants describing strategies they use to cope with CF and hospitalizations. Description of patients' experiences was incorporated into the program's intervention manual and patient workbook. Participants also provided direct feedback on the proposed program. Feedback was largely positive regarding program content and structure, suggesting the acceptability of a CF-specific CBT-based intervention for adults with CF. Features to increase accessibility of care including telehealth, inpatient delivery, and team-based care were perceived as advantageous, and participants emphasized the value of a CF-specific mental health intervention. Qualitative findings directly informed the development of CF-CBT, a cognitive-behavioral skills-based program to promote emotional well-being for adults with CF.
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Affiliation(s)
- Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Maysa M. Kaskas
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Beth A. Smith
- Department of Pediatrics, University of Buffalo School of Medicine, Buffalo, NY, United States
- Department of Psychiatry, University of Buffalo School of Medicine, Buffalo, NY, United States
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Landau EC, Verkleij M, Graziano S, Quittner AL, Georgiopoulos AM, Smith BA, Schechter MS, Abbott J. Mental health screening in Cystic Fibrosis as an intervention: Patient and caregiver feedback on improving these processes. Respir Med 2022; 202:106955. [DOI: 10.1016/j.rmed.2022.106955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
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Tickner C, Holland L, Wark P, Hilton J, Morrison C, Kay-Lambkin F, Heinsch M. Mental health care needs in cystic fibrosis: A scoping review. SOCIAL WORK IN HEALTH CARE 2022; 61:1-15. [PMID: 35422201 DOI: 10.1080/00981389.2022.2060422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 02/14/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
People with cystic fibrosis experience rates of anxiety and depression that are considerably higher than those of the general population. Research suggests low mental health functioning can lead to poor health outcomes and quality of life for this population. Consequently, recognition of the need for routine mental health screening and referral in cystic fibrosis care is increasing. Yet to date, less is known about the actual mental health care needs of people with cystic fibrosis. This scoping review sought to address this gap by examining the mental health care needs of adults and adolescents living with cystic fibrosis, and how are these needs are (or are not) being met. Findings suggest current efforts at mental health care provision do not adequately meet the needs of people with cystic fibrosis, highlighting the urgency of conducting high quality intervention research to support effective mental health care for this population.
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Affiliation(s)
- Campbell Tickner
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Lucy Holland
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Peter Wark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Jodi Hilton
- Paediatric Respiratory and Sleep Medicine Department, John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | - Cathy Morrison
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Milena Heinsch
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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Verkleij M, Georgiopoulos AM, Friedman D. Development and evaluation of an internet-based cognitive behavioral therapy intervention for anxiety and depression in adults with cystic fibrosis (eHealth CF-CBT): An international collaboration. Internet Interv 2021; 24:100372. [PMID: 33816126 PMCID: PMC8010637 DOI: 10.1016/j.invent.2021.100372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/05/2020] [Accepted: 01/15/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Individuals with cystic fibrosis (CF) are at increased risk for anxiety and depression, with negative consequences for adherence, health, and quality of life. New approaches to prevent and treat anxiety and depression that are tailored to the concerns of this population are needed. A CF-specific internet-based cognitive-behavioral therapy (CBT) intervention was developed to increase access to evidence-based mental health care and decrease cost and burden of care for people with CF. OBJECTIVE To evaluate the usability and acceptability of "eHealth CF-CBT," an internet-based program integrating therapist-guided online self-management modules with in-person or virtual sessions. METHODS Dutch adults with CF (N = 16) and CF health care providers (N = 16) systematically tested all sessions of the eHealth CF-CBT program, provided qualitative feedback, and completed measures including eHealth Impact Questionnaire (eHIQ), and System Usability Scale (SUS). RESULTS Patient and provider ratings of their overall impression of the eHealth CF-CBT program were high, with scores (mean; SD) of 8.3; 0.6 and 8.2; 0.8 respectively on a 10-point scale. Mean ratings of usability by patients (77.0/100) and providers (73.4/100) surpassed the SUS cut point for good favorability. Ratings (pooled mean; SD) on the assessed eHIQ domains Motivation and Confidence to Act (71.3; 10.0), Information and Presentation (78.9; 9.6), and Identification (62.0; 15.1) were positive, as were assessments of specific elements of session content and format. CONCLUSIONS eHealth CF-CBT is the first therapist-guided internet-delivered CBT-based intervention for adults with CF. Initial evaluation with key stakeholders demonstrated high levels of acceptability and usability and provided input that was integrated to strengthen the program. Effectiveness testing in the Netherlands will be the next step, as well as future international adaptation and dissemination.
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Affiliation(s)
- Marieke Verkleij
- Department of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Corresponding author at: Amsterdam UMC, location VU University Medical Center, Department of Pediatric Psychology, Reception L, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
| | | | - Deborah Friedman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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