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Relatives’ Education And Coping Toolkit. Systematic review to identify the key components of effective interventions for relatives of people with psychosis. Fiona Lobban, Adam Postlethwaite & REACT team. REACT. Grant Holders Fiona Lobban (PI - Spectrum f.lobban@lancaster.ac.uk )

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Systematic review to identify the key components of effective interventions for relatives of people with psychosis

Fiona Lobban, Adam Postlethwaite & REACT team


React l.jpg
REACT effective interventions for relatives of people with psychosis

Grant Holders

  • Fiona Lobban (PI - Spectrum f.lobban@lancaster.ac.uk)

  • David Glentworth (CI – GMW)

  • Vanessa Pinfold (Rethink)

  • Warren Larkin (LCT)

  • Relative, LCT- anonymous

  • Graham Dunn (Manchester University)

  • Gillian Haddock (Manchester University)

    Researchers

  • Laura Wainwright

  • Anna Clancy

  • Adam Postlethwaite – a.postlethwaite@lancaster.ac.uk

    TSC – Chair – Prof Karina Lovell

    Funders

  • This study is funded by NIHR – research for patient benefit. However, the views and opinions expressed within it do not necessarily reflect those of DH/NIHR


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Main Aim of REACT effective interventions for relatives of people with psychosis

To develop a supported self management package for relatives of people experiencing first episode psychosis

3 Phases

Phase 1 = Develop self management intervention

Phase 2 = Feasibility trial –

relatives’ outcomes

Phase 3 = Modify and disseminate


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Phase 1 effective interventions for relatives of people with psychosis

Systematic review

“what works?”

Focus Groups

“what are people

saying they need?”

Our “expert” opinion?

How does this feed in?

Intervention Reference Group

CBT principles

-understanding is key

-personalised

-build on existing strategies

-self as agent of change

-recovery focussed


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What has already been done? effective interventions for relatives of people with psychosis

Cochrane Review - Family intervention for schizophrenia. (Pharoah, Mari, Rathbone, Wong 2010 update)

  • Interventions with relatives of people with schizophrenia

  • 5+ sessions, compared to standard care

  • Primary outcomes –all for service users

  • Reduce relapse and hospital admission (but methodologically weak)

    Findings for relatives outcomes

    • Secondary family outcomes – very numerous

    • Conflicting results

    • Some evidence that can reduce EE (but methodologically weak)


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Systematic review- key questions effective interventions for relatives of people with psychosis

Key Questions

  • Do family interventions work for relatives?

    More specifically…..

    • What outcomes do they work on?

    • What are the key components in the ones that work?

    • Which factors (other than content) distinguish the ones that work from the ones that don’t?

    • What methodological issues do we need to be aware of?

      NB -Not specifically first episode (too limited)


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Method effective interventions for relatives of people with psychosis

Search Strategy

  • Electronic databases / references lists / experts

  • 2 independent reviewers

  • Inclusion

    • Peer reviewed

    • Evaluated intervention designed to support carer or relatives of people with schizophrenia or psychosis

    • Controlled study ie compared to something

    • Outcomes reported for carers

  • Exclusion

    • Reviews / case studies / discussion papers

    • Not in English

      Hand search reference lists

      Cross reference with Cochrane reviews


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    Data extracted effective interventions for relatives of people with psychosis

    • Effectiveness & outcomes

    • Intervention components questionnaire

      • Extracted key components & delivery methods

      • 1 = no 2 = not main focus 3 = main focus

    • Additional factors

      • Were relatives outcome main focus of study?

      • Were relatives selected for clinical baseline scores?

      • Therapy Factors – length, SU present, therapist training?

    • Clinical Trials Assessment Measure – CTAM (Tarrier & Wykes 2004)

      • Rate methodological quality of trial (0-100)


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    MEDLINE, AMED, PsycINFO and CINAHL databases were searched using the predetermined search terms

    755 articles identified and abstracts read

    634 articles excluded as did not meet inclusion criteria

    121 articles appear to meet inclusion criteria. Searched for terms control OR controlled OR comparison OR trial.

    67 articles excluded on new search criteria

    11 articles excluded as no carer outcomes reported

    54 article abstracts appear to meet criteria. Each full article read by two independent people.

    1 article excluded as no comparison group

    2 articles excluded as not evaluating an intervention designed for carers

    40 articles meet inclusion and exclusion criteria and so included in review.

    4 papers identified from Cochrane review update

    8 articles identified from reference lists as meeting inclusion criteria

    53 articles meet inclusion and exclusion criteria and so included in review.

    1 paper identified in unrelated literature search


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    Main outcomes using the predetermined search terms


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    Key components using the predetermined search terms



    Clinical baseline score relatives l.jpg
    Clinical baseline score – relatives? non-effective studies?

    Chi Square (1, N = 50) = 0.255, p = 0.683


    Relatives outcomes main focus of study l.jpg
    Relatives outcomes main focus of study? non-effective studies?

    Chi Square (1, N = 50) = 1.020, p = 0.502


    Su present l.jpg
    SU present? non-effective studies?

    Chi Square (1, N = 50) = 0.611, p = 0.520


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    Methodological Quality non-effective studies?



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    Key Questions – the answers non-effective studies?

    • Do family interventions work for relatives?

      YES!! …….but

      • What outcomes do they work on? Not clear

      • What are the key components in the ones that work? Lots of good stuff – but also don’t work

      • Which factors (other than content) distinguish the ones that work from the ones that don’t? None that we looked at

      • What methodological issues do we need to be aware of? Trial quality very poor


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    Conclusions non-effective studies?

    Lots of exciting work to do!

    • Well designed trials

      • CTAM as a guide?

    • Aimed at agreed outcomes

      • Consensus task?

    • Testing well defined interventions

      • Dismantling studies?


    Www reactstudy co uk l.jpg

    www.reactstudy.co.uk non-effective studies?

    Thank you!

    f.lobban@lancs.ac.uk

    a.postlethwaite@lancs.ac.uk