Effect of two educational interventions on knowledge and attitudes towards electroconvulsive therapy

Effect of an Educational Video and Information Pamphlet on Knowledge and Attitudes About Electroconvulsive Therapy: A Randomized, Blind, Controlled Study

OBJECTIVE

Electroconvulsive therapy (ECT) is considered an effective, yet underused and stigmatized form of psychiatric treatment. Public misconception can impact informed decision making, and therefore, it is important to educate the community with accurate and realistic representations of modern ECT. The aim of this study was to determine whether exposure to brief information packages developed in Australia leads to changes in attitudes and knowledge about ECT.

METHODS

A sample of 100 undergraduate psychology students and 88 volunteers from the general public were randomly allocated to view 1 of 3 resource packages (each containing an information pamphlet and videos totaling ~15 minutes): Concord Centre for Mental Health-Revised, Concord Centre for Mental Health-Original, and a generic information package on depression. Participants' attitudes and knowledge of ECT were assessed before and after psychoeducation using the Questionnaire on Attitudes and Knowledge of ECT (QuAKE).

RESULTS

Participants in the student and general population exposed to either ECT resource package showed significantly improved attitudes and knowledge of ECT compared with participants exposed to generic information about depression and its treatment. A fine-grained analysis of the QuAKE revealed that, although many aspects of knowledge and attitudes improved after exposure to ECT information packages, some remained unchanged.

CONCLUSIONS

Brief education through information resources in video and written format can markedly improve attitudes and knowledge toward ECT. Further research is recommended to determine whether the resources contribute to informed decision making of consumers with mental illness, especially those who are candidates for ECT.

Addressing Electroconvulsive Therapy Knowledge Gaps and Stigmatized Views Among Nursing Students Through a Psychiatrist-APRN Didactic Partnership

BACKGROUND: Knowledge gaps and stigmatized perceptions regarding electroconvulsive therapy (ECT) among patients and health providers contribute to the underutilization of an important therapeutic modality. The proactive education of future advanced practice registered nurses (APRNs) provides an opportunity to optimize the use of this evidence-based clinical practice. AIMS: As part of a general course in psychiatry during the first year of nursing school, we dedicated 1 hour to treatment-refractory depression, including ECT, and a second hour to a summary discussion of mood disorders. We evaluated the efficacy of this didactic offering, which was co-taught by a psychiatrist and a psychiatric APRN. METHOD: At baseline, consenting students (n = 94) provided three words they associated with ECT and then completed three validated instruments: (a) Questionnaire on Attitudes and Knowledge of ECT, (b) Opening Minds Stigma Scale for Health Care Providers, and (c) Self-Stigma of Seeking Help. Among the 67 students who repeated the assessment at endpoint, 39 attended the ECT didactic (Intervention group, 58%) and 28 did not (Control, 42%). RESULTS: After completion of the 3-month course, students showed improvement across all measures (p < .001). The only outcomes that improved differentially between the Intervention and Control groups were the Questionnaire on Attitudes and Knowledge of ECT Attitudes and Knowledge scales (p = .01). Word choice valence associated with ECT shifted favorably by endpoint (p < .001). CONCLUSIONS: An educational intervention co-led by a psychiatric-mental health APRN had a significant impact on nursing students' knowledge and perceptions of ECT. This approach can be readily implemented at other institutions. Future refinements will include the videotaped depiction of a simulated patient undergoing the consent, treatment, and recovery phases of ECT.

Rewiring practice: community mental health professionals’ attitudes towards and knowledge of electroconvulsive therapy in the context of advance decision-making

Purpose

In England, electroconvulsive therapy (ECT) cannot be administered to service users who make an advance decision to refuse the treatment, unless in life-threatening circumstances. In a sector where person-centred practice is revered, no prior research has investigated whether community mental health practitioners (CMHPs) encourage service users to make advance decisions about ECT. This study aims to explore whether CMHPs have supported advance decision-making about ECT and whether their profession, attitudes towards and knowledge of the treatment affect this.

Design/methodology/approach

A quantitative online survey was completed by n = 120 CMHPs (nurses, social workers and occupational therapists). The validated Questionnaire on Attitudes and Knowledge of ECT was used.

Findings

In total, 93% of participants knew service users who had undergone ECT, yet only 12% had supported a service user to make an advance decision about ECT. Compared to those who had not supported advance decision-making, those who had shown significantly higher knowledge and a more positive attitude. Nurses and those who had worked in the mental health field for over 10 years had significantly higher knowledge of ECT.

Originality/value

CMHPs are well placed to support advance decision-making about ECT. Increased knowledge about advance decisions and ECT may bolster the uptake of advance decision-making, thus greater training is recommended.

Effect of a Video-Assisted Teaching Program About ECT on Knowledge and Attitude of Caregivers of Patients with Major Mental Illness

BACKGROUND

Electroconvulsive therapy (ECT) is a widely used treatment modality for mental disorders such as major depression, bipolar affective disorder (BPAD) and catatonia. However, it is considered as one of the most controversial and misunderstood procedures, especially among caregivers.

METHODS

An experimental pre-test, post-test design was adopted. Forty caregivers of persons with schizophrenia (n = 12), depression (n = 13), BPAD with mania (n = 8), and BPAD with depression (n = 7) were selected using convenience sampling. The caregiver's knowledge and attitude toward ECT were assessed before and after the intervention with a single session video-assisted teaching on ECT. The data collection tool used to assess the caregiver's knowledge and attitude was based on a pre-validated questionnaire.

RESULTS

The pre-test evaluation demonstrated poor knowledge among 12 (30%) and a moderate level of knowledge on the remaining 28 (70%) of the study subjects. The attitude scores revealed a neutral attitude among 47.5% and a conservative attitude among 10% of the subjects toward ECT. There was a significant improvement in both mean (±SD) knowledge (13.4 ± 4.7 vs 25.6 ± 2.9) and attitude (10.7 ± 3.5 vs 14.6 ± 3.9) scores following intervention with video-assisted teaching.

CONCLUSION

A single session involving video-assisted teaching improves the knowledge and attitude toward ECT among caregivers by removing the myths and misconceptions about ECT.

Electroconvulsive Therapy: a Video-Based Educational Resource Using Standardized Patients

OBJECTIVE

Video-based depictions of electroconvulsive therapy (ECT) can be useful for educational purposes, but many of the readily available resources may worsen already stigmatized views of the procedure. Educators' common reliance on such material highlights the paucity of equipoised depictions of modern ECT well suited for the training of health professionals. The authors developed and tested a new educational module enhanced by videotaped depictions of a simulated patient undergoing the consent, treatment, recovery, and follow-up phases of ECT.

METHODS

The didactic intervention interspersed 7 short video clips (totaling 14 min) into a 55-min lecture on treatment-resistant depression. The session, part of an intensive course of preclinical psychiatry, was delivered online through synchronous videoconferencing with Zoom. The primary outcome measure was change in the Questionnaire on Attitudes and Knowledge of ECT (QuAKE).

RESULTS

Fifty-three out of 63 (87%) eligible second-year medical students completed assessments at baseline and after exposure to the didactic intervention. QuAKE scores improved between baseline and endpoint: the Attitudes composite increased from 49.4 ± 6.1 to 59.1 ± 5.7 (paired t 10.65, p < 0.001, Cohen's d 0.69), and the Knowledge composite from 13.3 ± 1.2 to 13.9 ± 0.8 (paired t 3.97, p < 0.001, Cohen's d 0.23).

CONCLUSIONS

These video-based educational materials proved easy to implement in the virtual classroom, were amenable to adaptation by end-use instructors, were well received by learners, and led to measurable changes in students' knowledge of and attitudes toward ECT.

A Randomized Controlled Trial of Video Psychoeducation for Electroconvulsive Therapy in the United States

OBJECTIVE

Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment that remains largely underutilized. Patient psychoeducation about ECT may improve uptake of this treatment.

METHODS

This randomized controlled trial compared two forms of psychoeducation about ECT: video psychoeducation and an informational brochure. In 2019, a national sample of 556 U.S. adults who screened positive for depression were recruited and randomly assigned to receive one of these educational interventions online. Participant perceptions, knowledge, and willingness to receive ECT were assessed before and after psychoeducation.

RESULTS

Both the video psychoeducation and brochure groups showed significantly more positive perceptions and knowledge about ECT following the intervention, with no significant differences between groups. The proportion of participants who reported being willing to receive ECT increased significantly after receipt of psychoeducation (from 31% to 63% in the video psychoeducation group and from 29% to 56% in the brochure group). Female gender, severity of depression, and comorbid mental and substance use disorders were associated with positive changes in ECT perceptions and increased willingness to receive ECT.

CONCLUSIONS

These findings suggest brief psychoeducation for ECT is needed and may improve acceptance of this robust treatment.

A Measure to Assess Perceptions and Knowledge About Electroconvulsive Therapy: Development and Psychometric Properties

OBJECTIVES

Although electroconvulsive therapy (ECT) has been found to be one of the most robust and rapid treatments for severe depression, it is widely underused partly because of negative perceptions and inaccurate knowledge about the treatment.

METHODS

The 18-item ECT Perception and Knowledge (ECT-PK) measure was developed through a systematic review of the literature, subject matter expert ratings, and examination of content validity. The ECT-PK consists of Perception and Knowledge subscales, which were tested on a national sample of 1091 US adults who screened positive for depression in 2018 through Amazon's Mechanical Turk platform.

RESULTS

Evaluation of the ECT-PK subscales found that both subscales demonstrated good construct validity, criterion validity, and internal consistency reliability. Participants who had higher Perception and Knowledge subscale scores were significantly more likely to report that they were willing to try ECT. The ECT-PK revealed that many participants reported fears about pain, brain damage, and memory loss resulting from ECT, and had inaccurate knowledge about ECT being outdated or lacking scientific evidence.

CONCLUSIONS

Together, these results showed that the ECT-PK is an efficient and effective contemporary tool to measure the perception and knowledge of ECT, and highlights areas in need of psychoeducation.

Knowledge and attitudes of adolescents with psychiatric disorders and their caregivers towards electroconvulsive therapy in China

BACKGROUND

Electroconvulsive therapy (ECT) is effective in treating adolescents with severe psychiatric disorders. This study examined the knowledge, experiences and attitudes of adolescents with severe psychiatric disorders and their caregivers towards ECT in China.

METHODS

A total of 158 participants, including 79 adolescents who received ECT and their caregivers (n = 79), were enrolled in this study. Their knowledge and experiences about and attitudes towards ECT were evaluated with self-administered data collection forms.

RESULTS

Only around half of patients and caregivers reported that they received sufficient information about the process, the therapeutic and side effects, and the risks of ECT, although most believed that ECT is beneficial, and around half believed that ECT is safe. Around one third of patients and caregivers reported that only critically ill patients should receive ECT. More than half of patients experienced side effects, such as memory impairment, headache and short-term confusion.

CONCLUSIONS

Sufficient information about ECT should be provided to adolescents with severe psychiatric disorders and their caregivers prior to treatment, with particular focus on the treatment process and possible side effects.

Effects of video psychoeducation on perceptions and knowledge about electroconvulsive therapy

This study examined the effects of video psychoeducation about electroconvulsive therapy (ECT) on perceptions and knowledge about ECT. A pre-post design was used with a national sample of 1,068 adults who screened positive for depression. Participants' perceptions and knowledge about ECT were assessed before and after watching a psychoeducational video about ECT. Participants showed significant increases in positive perceptions and accurate knowledge about ECT after watching the psychoeducational video. In the perception domain, the items "ECT can be lifesaving" and "fears that ECT can be painful" showed the largest positive increases. In the knowledge domain, items related to "ECT is one of the safest procedures performed" and "ECT can be given safely to older persons" showed the largest increases. Over 20% of participants changed their mind and reported they were willing to try ECT after watching the video. Together, these findings suggest video psychoeducation about ECT holds great potential to improve perceptions and knowledge about ECT, particularly as new technologies are developed to create, distribute, and host videos to reach large audiences.

Electroconvulsive Therapy: The Impact of a Brief Educational Intervention on Public Knowledge and Attitudes

The safety and efficacy of electroconvulsive therapy (ECT) are well established, yet efforts to educate the public about ECT advancements are lagging. The purpose of this study was to experimentally examine the impact of a brief educational intervention on public knowledge of, and attitudes toward, ECT. Participants ( n = 91) from a private liberal arts university in the upper Midwestern region of the United States were randomly assigned to either an educational intervention or a control group. The educational intervention group read a brief informational pamphlet about ECT. Both groups completed a 24-item ECT knowledge and attitude measure. Participants who read the ECT pamphlet demonstrated significantly higher levels of ECT knowledge and reported more favorable attitudes toward ECT than did the control group. Furthermore, knowledge of ECT significantly predicted attitudes toward the treatment. Educating the public about available medical treatments not only facilitates help-seeking behavior among prospective patients and their families, but also it hallmarks the informed consent process once help is sought.

Knowledge of and attitudes towards electroconvulsive therapy (ECT) among psychiatrists and family physicians in Saudi Arabia

OBJECTIVES

To assess the knowledge of and attitudes towards ECT among psychiatrists and family physicians in Saudi Arabia.

METHODS

The study is quantitative observational cross-sectional with a convenient sample that included psychiatrists and family physicians (including residents) in Saudi Arabia.

RESULTS

Of the 434 questionnaires emailed, a total of 126 returned completed questionnaires (29% response rate). The mean age of respondents was 35 years old. Psychiatrists accounted for 68.3%. The majority were Saudis (95.2%) and male (70.6%). Around half were consultants and about two-thirds (62.7%) had worked in a facility that used ECT. Psychiatrists showed better knowledge than family physicians in their answers, with a mean total knowledge scoring of 8.12 (±1.25) out of 10 and 6.15 (±1.25), respectively (P < 0.0001). Among psychiatrists, 87% thought that ECT required general anesthesia, while 35% of family physicians believed so (P < 0.0001). Other items of ECT knowledge are discussed. Psychiatrists displayed a better attitude towards ECT than family physicians in all answers, with a mean score of 9.54 (±1.16) and 7.85 (±2.39), respectively (P < 0.0001).

CONCLUSIONS

Psychiatrists scored better than family physicians in both knowledge and attitude regarding ECT.

Effectiveness of an Educational Intervention on Medical Students' Knowledge About and Attitude Towards Electroconvulsive Therapy

OBJECTIVE

This study was done to determine the effectiveness of a lecture and exposure to electroconvulsive therapy (ECT) followed by interaction with patient, on medical students' knowledge about and attitude towards electroconvulsive therapy.

METHODS

A questionnaire was administered to second year medical students to determine their baseline knowledge about and attitude towards electroconvulsive therapy. Following this, they underwent two educational interventions, a lecture on ECT and exposure to the procedure and interaction with the patient and relative, and their knowledge and attitude were reassessed after each intervention using the same questionnaire.

RESULTS

Eighty-one students completed all the three assessments. Students' knowledge about ECT at baseline was minimal (mean 3.58 out of 12). Their knowledge increased significantly after the lecture (mean 10.3), and there was further increase following exposure to the procedure and subsequent interaction with the patient and relative (mean 11.1). At baseline, students had an overall negative attitude towards ECT. There was significant improvement on all attitude items following the lecture. Exposure to the procedure resulted in further improvement in attitude regarding whether ECT is a cruel treatment and has to be used as a last resort.

CONCLUSIONS

Exposure to ECT in lecture and clinical scenarios followed by interaction with the patient should be included in the undergraduate medical curriculum to improve students' knowledge and attitude about this safe, effective, and potentially lifesaving treatment modality.

The Impact of A "Brief ECT Orientation Module" on The Knowledge and Attitudes of Medical Students Towards ECT in India

Background:

Electroconvulsive therapy (ECT) continues to be an intervention that attracts controversy in spite of its proven efficacy. There is limited literature on attitude and knowledge of medical students towards ECT from Asian and African countries.

Aim:

The current study assesses the impact of a “Brief ECT Orientation Module” on the knowledge of and attitudes of Indian medical students towards modified ECT.

Subjects and Methods:

The study was conducted at a tertiary care multi-specialty hospital associated with a government medical college. The students were administered the study questionnaire on Day 1 of Psychiatry clerkship. Following this, they were administered the Brief ECT Orientation Module. Assessment was made using a questionnaire with items related to knowledge and attitude towards ECT before and after “Brief ECT Orientation Module.”

Results:

Fifty-nine students completed the study. There was a significant improvement in knowledge of medical students on all the three domains of the questionnaire for assessment of knowledge about ECT-related facts. A change in attitudes towards ECT was also observed following Brief ECT Orientation Module, especially among those who witnessed ECT administration.

Conclusion:

The findings of the current study suggest that the Brief ECT Orientation Module is effective in improving the knowledge and attitude of medical students towards ECT.

Resident education in electroconvulsive therapy

OBJECTIVE

In 2001, the American Psychiatric Association's Task Force on electroconvulsive therapy (ECT) recommended that psychiatry residents should receive at least 4 hours of didactic instruction on ECT, participate in at least 10 treatments, and assist in the care of at least 3 patients receiving ECT. Residency accreditation requirements as of 2007, however, require only that training programs ensure competency in "understanding the indications and uses" of ECT. Anecdotally, training in ECT is said to vary widely between residency programs. The purpose of the study was to obtain more systematic information about ECT training.

METHOD

A survey was e-mailed to directors of all accredited psychiatry residency programs in the United States and Puerto Rico in early to mid 2008, requesting information regarding their didactic and clinical instruction in ECT and estimates of number of treatments provided by their institutions.

RESULTS

Responses were obtained from 91 training programs. Of these programs, 75% reported that some clinical exposure to ECT was required of their residents, but 37% estimated that the typical resident would participate in fewer than 10 treatments and 27% estimated that the typical resident would care for fewer than 5 patients receiving ECT. Most programs devoted less than 4 hours of lecture time to ECT. Most respondents believed that ECT was underused nationally; this perception did not differ based on the theoretical orientation of the training program.

CONCLUSIONS

This study suggests that resident education in ECT varies considerably between programs but is often less than that suggested by the American Psychiatric Association's Task Force.

Effect of an educational video on the accuracy of surrogate decisions: the case of electroconvulsive therapy

BACKGROUND

Under the amended Mental Health Act 2007, electroconvulsive therapy (ECT) can only be authorized in an incapacitated patient providing it is not in conflict with the decision of the donee of lasting power of attorney.

OBJECTIVES

To assess the ability of surrogates to correctly predict a subject's preference for treatment with ECT both before and after viewing an educational video. The effect of the educational video on attitudes to ECT was also examined.

METHODS

Twenty-five subject-surrogate pairs were recruited from relatives of psychiatric patients. The subjects' treatment preferences regarding the ECT and the surrogates' predictions of these preferences were assessed by means of 2 hypothetical scenarios before and after viewing an educational video. An attitude to ECT questionnaire (Questionnaire on Attitudes and Knowledge of ECT) was completed by all participants before and after the video.

RESULTS

Subject-surrogate concordance was high, 84% for scenario 1 (treatment-resistant depression) before and after the video. In scenario 2 (life-threatening depression), concordance rose from 80% before the video to 96% after the video. The greatest increase in concordance occurred in pairs in which neither subject nor surrogate had previous experience of ECT. Attitude scores were significantly more positive after the video.

CONCLUSIONS

Surrogates were able to predict the subjects' preference for ECT with high levels of accuracy. This finding is contrary to similar studies involving end-of-life treatment. Providing surrogates with clear, detailed, and accurate information about the proposed treatment may improve surrogate accuracy particularly in treatments such as ECT where widespread misperceptions prevail.

Electroconvulsive therapy: Part II: a biopsychosocial perspective

The myths surrounding electroconvulsive therapy (ECT) and the misconceptions held by the general public, clinicians, and patients have interfered with acceptance of this treatment throughout its history. Misunderstandings surrounding ECT, and its consequent stigmatization, are reviewed, including negative depictions of ECT in film, print media, and on the Internet. Clinicians involved in the delivery of ECT benefit from gaining an understanding of how ECT may be perceived by patients and other mental health professionals; they can play a vital role in educating patients and helping ensure the delivery of a successful course of ECT. Guidance is provided for clinicians on how to support patients and families through the ECT process using a model team approach. Anxiety reduction, meeting individual needs, patient and family psychoeducation, assessment of psychosocial supports, and discharge planning are discussed.

Examination of the effect of education about electroconvulsive therapy on nursing practice and patient satisfaction

INTRODUCTION

Electroconvulsive therapy (ECT) procedures require the work of a multidisciplinary team that includes an anesthesiologist, a psychiatrist, and a treatment nurse. Electroconvulsive therapy is treated like a minor surgical procedure that requires preoperative preparation and postoperative care.

AIM

This research was conducted as a quasi-experimental study for the purpose of evaluating the effect of education about ECT given to nurses who work on a psychiatric ward.

SAMPLE

The research pretest sample was composed of 52 ECT procedures in which nurses participated in managing that were conducted between April and October 2006 on the psychiatric ward of Dokuz Eylül University Hospital. The posttest sample was composed of 52 ECT procedures in which nurses participated in managing that were conducted between January and March 2007 on the same psychiatric ward. DATA COLLECTION TOOL: The observation form for the determination of nursing care in ECT and satisfaction form, which were developed by the researcher from expert opinion, were used for data collection. Data obtained were analyzed using the test for significance between 2 means.

RESULTS

The nurses included in the research received a total score of 4 for nursing care in ECT procedure before education and X = 11.5 after education. The difference in the mean scores for nursing care in ECT procedure before and after education was found to be statistically significant (P < 0.05). The mean score for patient satisfaction with nursing care in ECT procedure before education was X = 2.5 and that after education was X = 4.1. The difference between the 2 means was found to be statistically significant.

CONCLUSIONS

Education given to nurses about ECT improved nursing practice and increased patient satisfaction. For this reason, it is recommended that nursing care in ECT continuing education be planned and given at regular intervals.

Knowledge and attitudes toward electroconvulsive therapy among health care professionals and students

Widespread variations in electroconvulsive therapy (ECT) prescription between and within countries have led many researchers to study professionals' attitudes to the procedure. A questionnaire looking at knowledge and attitudes was administered to 593 medical and nursing students, psychiatrists and anesthetists, and theater and psychiatric nurses. Respondents were based in 2 Irish cities, Dublin and Cork. Poorer knowledge of ECT was found in the nursing group, and this included psychiatric nurses: a third overestimate ECT mortality, most did not know if it caused permanent brain damage, and only 1 psychiatric nurse (2.9%) expressed positive attitudes to its use. Nursing students had significantly lower knowledge and more negative attitudes than medical students, and exposure to the procedure of ECT failed to improve their attitudes. The strongest predictor of better knowledge and more positive ECT attitudes was membership of the medical group. There were direct associations between better knowledge and more positive attitudes in the medical group but not among the nursing group. Low ECT knowledge among psychiatric nurses has implications in obtaining patients' valid consent. Our failure to link exposure to ECT to better nursing attitudes is discussed along with other educational lessons.

Electroconvulsive therapy: attitudes and misconceptions

This article deals with the current literature regarding general attitudes toward electroconvulsive therapy (ECT), and why there are so many misconceptions regarding this form of treatment. MEDLINE, PsychLIT and internet searches were carried out to gather the information discussed. Considerable stigma still surrounds ECT, and this probably remains the greatest barrier to public acceptance of this treatment.