Improving psychological therapies for older adults by advancing understanding of patient preferences

Background: Evidence-based practice requires using the best research evidence, clinical expertise, and patient characteristics/preferences to inform the provision of appropriate interventions. Although accommodating patient treatment preferences can have a significant positive impact on psychotherapy attendance and outcome, they are often overlooked in clinical decision-making. Aims: To establish the feasibility and acceptability of using self-report questionnaires to elicit older adults’ (OAs) mental health treatment and outcome preferences and determine whether clinicians consider these preferences when selecting treatment. The secondary aim is to establish a preliminary understanding of participants’ responses on the questionnaires. Methods: Two questionnaires were adapted from previous research for this study. Patients were recruited from NHS Lanarkshire Psychological Therapies for Older People service and asked to complete a questionnaire about their preferences for psychological therapy. Clinicians who deliver psychological therapies to OAs were recruited and asked to complete a questionnaire about their decision-making. Participants also rated questionnaire acceptability. Results: 18 patients and 27 clinicians were recruited. Patients expressed preferences for therapy delivered in-person. Their most preferred therapy task was ‘learn ways to be less critical of me’ and outcome was ‘feel more confident’. Clinicians rated their clinical experience as the most influential factor in their decision-making about treatment. They also identified patient insight and previous experience of therapy as the factors with the most influence on whether they consider patient preferences in decision-making, and reported that COVID-19 makes accommodating patient preferences more difficult. Conclusions: questionnaires are a feasible and acceptable method of eliciting OAs’ treatment and outcome preferences and gathering data about clinicians’ decision-making