Table 4

Experts' ratings: Choice of psychological therapy

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


*Items suggested by experts in the first round and rated by the group in the second round

Rayner et al. BMC Palliative Care 2011 10:10   doi:10.1186/1472-684X-10-10

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