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Harnas SJ, Knoop H, Sprangers MAG, Braamse AMJ. Defining and operationalizing personalized psychological treatment - a systematic literature review. Cogn Behav Ther 2024; 53:467-489. [PMID: 38535891 DOI: 10.1080/16506073.2024.2333345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
This systematic literature review aimed to propose a definition of personalized psychological treatment and to suggest how the definition can be operationalized. PsycINFO, Cochrane Library, MEDLINE and EMBASE were searched up to 11 December 2023 for studies in which a definition of personalized psychological treatment was included or a systematic operationalization of personalized psychological treatment was described. Based on a narrative synthesis of the collected definitions, summary categories were developed that informed the proposed definition. Operationalizations were described according to what aspect of treatment, how and when treatment was personalized. The extent to which the operationalizations deviated from the proposed definition was assessed. Thirty-four studies with definitions and 200 with operationalizations were included. The following definition was proposed: personalized psychological treatment aims to optimize treatment outcome for the individual patient by tailoring treatment to unique or specific needs, preferences or other characteristics and includes a systematic adaptation of treatment or a differentiation between treatment strategies. Based on the operationalizations, timing of personalization, specification of the systematic approach and treatment elements that could be personalized were added to the proposed definition. Evidence-based personalization of psychological treatments can be enhanced by clear operationalization based on a comprehensive definition of personalization.
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Affiliation(s)
- Susan J Harnas
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Cancer Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, The Netherlands
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Gouveia K, Sprague S, Gallant J, Del Fabbro G, Leonard J, Bzovsky S, McKay P, Busse JW. In-person cognitive behavioural therapy vs. usual care after surgical management of extremity fractures: an unsuccessful feasibility trial. Pilot Feasibility Stud 2024; 10:2. [PMID: 38184642 PMCID: PMC10770933 DOI: 10.1186/s40814-023-01430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture. METHODS Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery. RESULTS Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria. CONCLUSION Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program. TRIAL REGISTRATION ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Jodi Gallant
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Gina Del Fabbro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Jordan Leonard
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Paula McKay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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