A novel biopsychosocial, cognitive behavioural, stepped care intervention for patients with non-cardiac chest pain

摘要

Background : Non-cardiac chest pain (NCCP) is associated with psychological distress, work absenteeism, impaired functioning and reduced quality of life. This study explores how a novel biopsychosocial, stepped-care treatment for NCCP works, and explores outcomes at each step and process variables. Methods : Patients with persistent NCCP were referred to a new biopsychosocial, multidisciplinary clinic for chest pain (CP). There were three possible ‘steps’ of treatment: (1) biopsychosocial assessment (BA) only, (2) BA plus low-intensity cognitive behaviour therapy (CBT) and (3) BA plus high-intensity CBT. Outcome measures assessed chest pain (frequency and interference), anxiety (GAD7), depression (Patient Health Questionnaire-9 (PHQ-9)), somatic symptoms (PHQ-15) and illness perceptions (Brief Illness Perception Questionnaire ) at baseline, 3 and 6 months post-assessment. Participants gave feedback about treatment once completed, which was analysed using content analysis. Results : Significant improvements were found on all outcome measures at 3 months and 6 months compared to baseline. Benefits were found in all treatment steps and occurred regardless of baseline distress, chest pain or demographic characteristics. The strongest predictor of improvement in chest pain at 6 months was a positive change in illness perceptions at 3 months. Patients reported how treatment helped by increasing their understanding of chest pain, reducing concern and improving their sense of control. Conclusions : A biopsychosocial, stepped-care intervention appears to be effective, efficient and acceptable for a variety of patients with NCCP. Changes in beliefs about chest pain were the main predictors of improvement (reduced chest pain interference and frequency) at 6 months follow up.