Do improved patient recall and the provision of memory support enhance treatment adherence?

https://doi.org/10.1016/j.jbtep.2016.08.017Get rights and content

Highlights

  • Patient's treatment adherence is relatively understudied in psychosocial treatments.

  • Patient recall and Memory Support (MS) are important factors for treatment adherence.

  • Patient recall of treatment contents was associated with improved adherence.

  • Therapist use of Application (a specific MS) was associated with improved adherence.

Abstract

Background and objectives

Patient adherence to psychosocial treatment is an important but understudied topic. The aim of this study was to examine whether better patient recall of treatment contents and therapist use of memory support (MS) were associated with better treatment adherence.

Methods

Data were drawn from a pilot randomized controlled trial. Participants were 48 individuals (mean age = 44.27 years, 29 females) with Major Depressive Disorder randomized to receive either Cognitive Therapy (CT) with an adjunctive Memory Support Intervention (CT + Memory Support) or CT-as-usual. Therapist and patient ratings of treatment adherence were collected during each treatment session. Patient recall was assessed at mid-treatment. Therapist use of MS was manually coded for a random selection of sessions.

Results

Patient recall was significantly associated with better therapist and patient ratings of adherence. Therapist use of Application, a specific MS strategy, predicted higher therapist ratings of adherence. Attention Recruitment, another specific MS strategy, appeared to attenuate the positive impact of session number on patient ratings of adherence. Treatment groups, MS summary scores and other specific MS strategies were not significantly associated with adherence.

Limitations

The measure for treatment adherence is in the process of being formally validated. Results were based on small sample.

Conclusions

These results support the importance of patient recall in treatment adherence. Although collectively the effects of MS on treatment adherence were not significant, the results support the use of certain specific MS strategy (i.e., application) as a potential pathway to improve treatment adherence. Larger-scale studies are needed to further examine these constructs.

Section snippets

Participants and procedures

Data were provided by participants who were recruited to participate in a pilot randomized controlled trial reported elsewhere (Harvey et al., 2016). Participants were forty-eight adults with Major Depressive Disorder (MDD), who were randomized to receive 14 weekly, 50-min sessions of either Cognitive Therapy as usual (CT-as-usual) or Cognitive Therapy plus Memory Support (CT + Memory Support). The study was approved by the Committee for the Protection of Human Subjects (CPHS) at the University

Results

Table 2 presents the descriptive statistics for all study variables in the total sample as well as in each randomized group (CT + Memory Support vs. CT-as-usual), including the therapist and patient ratings of treatment enactment and receipt, all the continuous MS variables (i.e., Total MS, No. of MS types, MS bundles ≥2, MS bundles ≥3, and specific MS strategies), and patient recall of treatment contents at mid-treatment. The ICCs were 0.43 (99% CI: [0.26, 0.63]) and 0.44 (99% CI: [0.25,

Discussion

The current study examined the extent to which patient recall and therapist use of MS were associated with patient adherence to cognitive therapy for depression. Because the two randomized treatment groups (CT + Memory Support vs. CT-as-usual) differ only in terms of the levels of MS therapist provided, we elected to focus on examining patient recall and the degree of MS used in relation to treatment adherence for the whole sample to improve statistical power, in addition to examining the

Acknowledgements

This research was supported by National Institute of Mental Health Grants R34 MH094535. The authors declare that there are no conflicts of interest. We acknowledge the contribution of Xin Zhao and Stacie Ong for additional coding of the memory support variables.

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      Finally, the relationship between memory and learning of treatment contents and outcome may depend on the timing relative to treatment. Studies investigating memory and learning of treatment contents and outcome on a shorter timeframe (i.e., week-to-week during treatment) have generally found significant relationships between these variables (Dong, Lee, et al., 2017a; Dong et al., 2017; Gumport et al., 2015; Lee & Harvey, 2015). Studies that investigated the association between memory and learning of treatment contents and outcome on a longer timeframe (e.g., months to years after treatment ended) tended to not find significant relationships between these variables (Chambers, 1991; Gumport et al., 2018; Hahlweg & Richter, 2010).

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