Can Respiratory Professionals Deliver a Cognitive Behavioural Approach? The Tailored intervention for ANxiety and DEpression Management in COPD (TANDEM) study

Clinical Research Results Abstract IntroductionSymptoms of depression and anxiety in COPD are common with up to 40% of individuals suffering such co-morbidities. Encouragingly, psychological treatments such as cognitive behaviour therapy have been shown to be effective in this population, however high levels of demand and long waiting times for specialist services mean there is considerable unmet need. The TANDEM trial, that investigated whether respiratory professionals could be trained to deliver a cognitive behavioural approach intervention to people with COPD and with anxiety/depression, had no impact on mental health or other outcomes. To provide insight into this negative result, we aimed to assess whether the intervention was delivered with fidelity.MethodsExperienced respiratory professionals working with COPD, interested in the psychological aspects of care, were invited to apply to be TANDEM facilitators. Following successful interview, three days face to face training was delivered. Post training assessment included a videoed role play with an actor which was coded using the Cognitive First Aid rating scale (CFARS). A minimum score of 27 was required to pass the training. Delivery of skills in practice was assessed by audio-recording sessions and coding using a bespoke fidelity tool.Results 31 (91%) of 34 trainees passed the training course with a mean post-training score of 33 (range 21-41). For delivery in practice during the trial, the mean CFARS score was 35.3 (SD=7.2). The highest competency was seen in “interpersonal relationships” and the lowest in “guided discovery”. Adherence to content of the intervention was high (>80%) for all of the core content except agenda setting which was only completed in 61% of cases.DiscussionRespiratory professionals can be trained to deliver a CBA intervention with competency and good fidelity. These findings may be particularly important in primary care where many patients have co-morbid physical and mental health concerns. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment. References and Clinical Trial Registry Information ISRCTN59537391