Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 17:4:1296596.
doi: 10.3389/frhs.2024.1296596. eCollection 2024.

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons)

Adrian Wells  1   2 , David Reeves  3   4 , Andrew Belcher  2 , Paul Wilson  3 , Patrick Doherty  5   6 , Lora Capobianco  2
Affiliations

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons)

Adrian Wells et al. Front Health Serv. .

Abstract

Background: Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023).

Methods: Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory.

Discussion: The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation.

Trial registration: NCT05956912; 13th July 2023.

Keywords: anxiety; cardiac rehabilitation; implementation; mental health; metacognitive therapy.

PubMed Disclaimer

Conflict of interest statement

AW is the director of the MCT-Institute and developer of MCT. He has written books on cognitive behaviour therapy and MCT. He is chief investigator on grants; NIHR201495; NIHR35997, and co-CI on NIHR203634. LC is the chief investigator on NIHR203634, and PD is a co-applicant on grant NIHR203634. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Similar articles

See all similar articles

References

    1. World Health Organization (WHO). WHO Global NCD Action Plan 2013–2020 [Internet]. 2013 [cited 2023 12]. Available online at: https://www.who.int/nmh/events/ncd_action_plan/en/
    1. Muka T, Imo D, Jaspers L, Colpani V, Chaker L, van der Lee SJ, et al. The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol. (2015) 30(4):251–77. 10.1007/s10654-014-9984-2 - DOI - PubMed
    1. Meijer A, Conradi HJ, Bos EH, Thombs BD, van Melle JP, de Jonge P. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis of 25 years of research. Gen Hosp Psychiatry. (2011) 33(3):203–16. 10.1016/j.genhosppsych.2011.02.007 - DOI - PubMed
    1. Palacios J, Khondoker M, Mann A, Tylee A, Hotopf M. Depression and anxiety symptom trajectories in coronary heart disease: associations with measures of disability and impact on 3-year health care costs. J Psychosom Res. (2018) 104:1–8. 10.1016/j.jpsychores.2017.10.015 - DOI - PubMed
    1. Baumeister H, Haschke A, Munzinger M, Hutter N, Tully PJ. Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review. Biopsychosoc Med. (2015) 9:11. 10.1186/s13030-015-0039-z - DOI - PMC - PubMed

Associated data

LinkOut - more resources