The HOME study - Michael Sharpe s CBT for the elderly

I wouldn't assume that just publishing a statistical analysis plan with more information means that there were protocol deviations. It could just go into more detail about exactly how the outcomes in the protocol will be presented, so it's worth being careful to check for specific changes before claiming that there were any.

 

Michael Sharpe is 66

eta:
https://www.bmj.com/content/354/bmj.i4231.full
https://sci-hub.tw/10.1136/bmj.i4231

 

Only an update to the published trial protocol.

Study paper still seems not published yet.

Study website:

https://oxfordpsychologicalmedicine.org/thehomestudy/

Edited to add: Maybe the title of this forum thread is misleading regarding CBT? Couldn't find any hint that patients will be (primarily) offered CBT. Could well be they (also) will be prescribed drugs or other interventions after being screened for dementia, depression etc.?

 

From the study protocol:

"The social problems include delays in organising post-discharge care arrangements, family members’ expectations or concerns about where the patient will go when leaving hospital, and miscommunications and conflicts about discharge planning within the clinical team. Failure to effectively manage these problems is well documented [7]."

So "proactive psychological medicine" is thought to cure hospital staff's problems with communication and discharge management?

 

Uh. Ironically, most of this would fall under customer support, and it's mostly paperwork and coordination. It's definitely good to do customer support, no one is above it.

Medicine proudly boasts about not doing customer support, confusing it for "the client is always right".

So their big idea seems to be customer support, but coaxed in a way that is acceptable to professionals who think healthcare shouldn't do customer support. I guess. Hard to say.

Have to say but this list of problems will be easily solved with AI. Which is good, but no need for the silly stuff to make it acceptable, it'll just work.

 

The important bit is that it is 'someone else's job'. Just like they term as 'mental health'/see it as 'a separate department' rather than realising that really if they accurately knew what that term was at all then they'd change how they acted to not harm people e.g. look into length of time people wait for test results works better than sending them off to someone to 'help them with the anxiety of having to wait months to find out how bad it is'.

It sort of makes it blinking obvious the one cheap bit where they can bring in anyone and train them in anything they fancy is - now they don't need people with the proper British Psychological Society background of training needs (which is quite specific for first degree) to do these courses as it is 'just about delivering the course' you don't need the knowledge to check whther the diagnosis is right or the course is right. This job sounds like one which is a sub for having good Occupational Therapists and social care professionals and so on.

Of course the issue is, if this is what they are doing, then de-skilling into the hands of these people who measure their 'worth' on inference and dodgy surveys - and of course like anyone wants to keep their job and get that pat on the back - by doing so he is creating a vicious circle once those in that area start 'doing research' on it because there will only be one answer from it. Which I guess flags the research issue for the area, it is a self-fulfilling prophecy whilst the standards for this niche of psych are so low and it is allowed to exist and continue this way.

One thing I've also noticed is that they don't do process change it seems - in other organisations you'd look at 'customer journey' or experience and blueprint what it must be like to walk in that. Now with the NHS I guess the excuses are numerous as to 'we do it this way' which don't necessarily hold other than for cognitive dissonance and covering that utter lack of function, but it really does seem to be a case that any issues their 'service' causes or has or doesn't address = 'add-on required to fix'. Like their facilities for other conditions being accessible to those with disabilities. It's just weird they don't build e.g. cancer wards for wheelchair users as standard given if it is usable for that then it is usable for all.

And the 'CBT attitude' is about reframing so the problem 'is that of the patient' not them. It isn't good reframing, and isn't about mental health. It really helps with their customer satisfaction surveys being worded right to get the right results. It's about making what they see as the square peg fitting what they believe to be a round hole. I'm guessing because being open to feedback and criticism and empathy (in the genuine meaning of the world where you look at whether the service fits the needs of the user by walking in their shoes rather than standing back and saying 'that'll do for them') weirdly just doesn't happen in the sector.

And I'm not saying this is individuals necessarily but clearly the 'system' blocking even those who might want to do that - where in another sector those who do drive these things forward are encouraged, and all eventually have to at least pretend to be nodding towards this. I note some saying what the 'NIHR' funding is (vs MRC) and wonder whether this is them thinking they are doing that, but it really is poor because they've used the worst approach to that you could possibly have and it misses the point by getting in those who are distancing it further from the end-user in the name of that individual 'making a name' and it becomes 'initiative-focused' rather than 'customer-oriented'.

 

Nope it is 'service management' and should be if outsourced being done by service marketers or managers who are pros in good customer-oriented service. Along with experts in the right medical specialisms/allied areas.

I'm cynical enough to think bunging it under a pseudo-psych term, and the history of this individual might be about weakening the voice/testimony of the customer ie power and weaponising that label of mental health. Not having a stair lift ready for when they get home after a hip op isn't a 'mental health issue the patient needs to take responsibility for', so I can assume he is selling the usefulness of this 'indirectly' ie not to the end-user of the patient.

 

I remember when I was in A&E about 10 years ago; an elderly lady was in the cubicle next to me; I gleaned that she had had a fall and probably broken her arm, but it was also obvious (or it was to me anyway) that she was also mentally distressed as she was rambling on about all kinds of weird things. What struck me at the time was the way the nurse was asking her all the standard questions about allergies etc but clearly getting nowhere as she (the patient) didnt really answer any of the questions and was obviously confused.

In one of the opening paragraphs of the Home study

I'm sorry but in this instance and I imagine in most others it was bleeding obvious, busy ward or not. You don't need some wandering psych to assess people.

 

What? I always thought he was a few years older than me. He looks so distinguished to be just 66!!

 

that was in 2020

 

In UK, are people allowed to stay overnight with their partners/parents/kids in the hospital? Not since Covid, but previously in US it was normal for them bring a cot for you to sleep and stay there next to the person, assuming the person's condition permitted it. I mostly lived in the hospital next to my late partner when he was in for a week or two many years ago.