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Journal ArticleDOI

Patients' views on the quality of care when receiving electroconvulsive therapy

01 Nov 2007-Psychiatric Bulletin (The Royal College of Psychiatrists)-Vol. 31, Iss: 11, pp 414-417
TL;DR: Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT, and the quality of the waiting and post-recovery areas.
Abstract: AIMS AND METHOD To examine patients’ views on the quality of care they received before, during and after electroconvulsive therapy (ECT), a questionnaire was completed by 389 patients who had received ECT at ECT Accreditation Service (ECTAS) member clinics. RESULTS The nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65% or more respondents. Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT. Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas. CLINICAL IMPLICATIONS Patient views are important indicators of quality of care and should be used to improve ECT practice. Anxiety about ECT is helped by supportive and caring staff. Improvements could be made to practices related to waiting for and recovering from ECT.

Summary (2 min read)

The nine key standards set by ECTAS

  • Most patients found staff friendly and reassuring and often commented on how this had helped reduce their anxiety prior to ECT.
  • Patients were less positive about standards relating to being introduced to staff prior to ECT, and the quality of the waiting and post-recovery areas.
  • In response to these problems, the ECT Accreditation Service was launched in 2003, with the objective of improving the quality of ECT in the UK.
  • A patient-centred approach is increasingly regarded as crucial for the delivery of high-quality care.
  • In recent years there has been much interest in the views and experiences of patients who have undergone ECT (Rose et al, 2003; Philpot et al, 2004), although this has not been focused on patients’ perception of the quality of care they received.

Method

  • The ECTAS process involves a period of self-review against standards of best practice, followed by a peer review visit to validate these findings.
  • This study was carried out in ECTAS member ECT clinics between September 2004 and February 2006.
  • Questionnaires were distributed by staff at ECTAS member clinics to patients who had recently undergone ECT.
  • Data were analysed quantitatively, to assess the proportion of patients whose care met the chosen standards.
  • Qualitative data were analysed thematically by the three authors separately, who then met to agree a final coding framework.

Results

  • Table 1 shows questions asked and quantitative results.
  • The impact of not having to wait on allaying anxiety was illustrated by this patient: [Waiting] ‘Usually 5-10 minutes.
  • In response to a question asking patients’ views on how the experience could have been improved, 10 patients referred to too much waiting either before or after treatment; 5 patients commented that they would have liked more reassurance from staff, and a further 5 stated that they would have appreciated more support afterwards.
  • ‘The whole procedure terrified me initially - just the thought of it.
  • Staff supporting family members was another aspect of care raised by patients (n=6): ‘All the staff in the ECT unit at [the] hospital are very friendly, are caring in their approach to each other, their patients and relatives.

Discussion

  • The main strength of the study was its multicentred design with a nationwide representation of patients’ views coming from over half of the country’s ECT clinics.
  • The sample, therefore, may not be representative of all patients.
  • Over 70% of patients rated eight of the nine key standards as having been met.
  • Clinics should continue to involve family members in the treatment process, if relevant, which helps to reassure both the patient and their family members, who often share the burden of the illness.
  • The current study adds to the literature in suggesting that other factors, such as reassurance about the safety of the procedure and personal attention from staff, should be considered when assessing patient’s satisfaction with ECT.

CRAGWORKINGGROUP ONMENTAL

  • ILLNESS (2000) National Audit of ElectroconvulsiveTherapy (ECT) in Scotland.
  • Scottish Executive Health Department, Clinical Resources and Audit Group.

CRESSWELL, J., RAYNER, L., &HOOD, C.

  • (2005) The ECTAccreditation Service : Standards for the Administration of ECT (3rd edn).
  • Royal College of Psychiatrists’ Research and Training Unit.

CRESSWELL, J., RAYNER, L., HOOD, C.,

  • Et al (2006) The ECTAccreditation Service : Standards for the Administration of ECT.
  • FOX, H. (1993) Patients’ fear of and objection to electroconvulsive therapy.

LELLIOTT, P. & DUFFETT, R. (1998)

  • PHILPOT, M., COLLINS, C.,TRIVEDI, P., et al (2004) Eliciting users’ views of ECT in twomental health trusts with a userdesigned questionnaire.
  • ROSE, D.,WYKES,T., LEESE, M., et al (2003) Patients’perspectives on electroconvulsive therapy: systematic review.
  • To obtain reprints or permission to reproduce material from this paper, please to this article at You can respond /letters/submit/pbrcpsych;31/11/414 from Downloaded The Royal College of PsychiatristsPublished by on October 18, 2017http://pb.rcpsych.org/.

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Psychiatric Bulletin (2007), 31, 414 ^417. doi: 10.1192/pb.bp.107.014 860
KERRY KERSHAW, LAUREN RAYNER AND ROBERT CHAPLIN
Patients’ views on the quality of care when receiving
electroconvulsive therapy
AIM S AND ME TH OD
To examine patients views on the
qualityofcaretheyreceivedbefore,
during a nd a fter elec troconvulsive
therapy (EC T), a questionnaire was
complete d by 3 8 9 patie nts w ho had
received EC T at EC TAccreditation
Ser vic e (EC TAS ) member clinic s.
RESULTS
TheninekeystandardssetbyECTAS
relating to quality of patient care
wereratedashavingbeenmetby
65 % or more re spondent s. Mos t
patients found s taf f f riendly and
reas suring and of ten commented on
how this had helpe d reduce their
anxiet y prior to EC T. Patients were
less positive about standards relating
to being introduc ed to s taf f prior to
EC T, and the quality of the waiting
and po st- rec over y areas.
CLIN ICAL IM PLICATIONS
Patient vie ws are imp ort a nt indi c a -
tors of quality of care and should be
use d to improve ECT prac tice. Anxiety
ab ou t ECT i s helped by supp or tive
and caring s taf f. Improvements could
be made to prac tice s related to
waiting f or a nd re co verin g f rom EC T.
Electroconvulsive therapy (ECT) is an effective treatment
for patients with major depressive disorder, mania and
catatonia (Kho
et al
, 2003; UK ECT Review Group, 2003).
However, audits have r epeatedly shown deficits in the
standard of the delivery of ECT (Lelliott & Duffett 1998).
In response to these proble ms, the ECT Accreditation
Service (ECTAS) was launched in 2003, with the objective
of improving the quality of ECT in the UK. ECTAS aimed
to achieve this by maintaining a database of standards in
the administration of ECT, reviewing ECT c linics and
accrediting those judged to provide a satisfactory service
to patient s. The ECTAS standards were developed from
key documents, including the ECT Handbook (Royal
College of Psychiatrists, 2005), the National Institute for
Health and Clinical Excellence’s (NICE) appraisal of ECT
(National Institute for Clinical Excellence, 2003) and t he
Scottish National Audit of ECT (CRAG Working Group on
Mental Illness, 2000). They were subject to extensive
consultation with all professional groups involved in ECT
and with service users and their representative organisa-
tions (Cresswell
et al
,2005).
A patient-centred approach is increasingly regarded
as crucial for the delivery of high-quality care. This is
particularly important considering the finding that for
some patients ECT is a frightening and unpleasant
experience (Fox, 1993). In recent y ears there has been
much interest in the views and experiences of patients
w ho have undergone ECT (Rose
et al
,2003;Philpot
et al
,
2004), although this has not been focused on patients’
perception of the quality of care they received.The aim of
this study is to determine whether the care of p atients
receiving ECT met the standards of best practice set by
ECTAS.
Meth od
The ECTAS process involves a p eriod of self-review
against standards of best practice, followed by a peer
review visit to validate these findings. There are
approximately 150 ECT clinics in England, Wales and
Northern Ireland. ECTAS membership is voluntary, and at
the time of the study 80 ECT clinics had signed up to the
service. This study was carried out in ECTAS member ECT
clinics between Septemb er 2004 and February 2006.
Upon joining ECTAS, member clinics were sent 20
copies of a patient questionnaire, as part of their self-
review. The questionnaire was designed by health
professionals and service users to assess the experience,
knowledge and attitu des of patients treated with ECT.
There were nine questions relating to quality of care, that
could be answered yes’, no, partly or don’t know. Each
was followed by a space for additional comments. There
were two open-ended questi ons relating to quality of
care, and patients were al so able to make general
comments about their experience of ECT at the end of
questionnaire.
Questionnaires were distributed by staff at ECTAS
member clinics to p atients who had recently undergone
EC T. T hey were completed anonymously by 389 patients,
w ho posted them to staff at ECTAS. In total, 1600
questionnaires were sent out to member clinics. However,
because some clinics did not send out all 20 quest ion-
naires, the response rate can only be est imated. For the
18 most recently reviewed clinics, ECTAS recorded the
number of questionnaires the clinic sent to patients, as
well as the number of questionnaires returned. For these
clinics the response rate was 37%. Data were analysed
quantitatively, to assess the prop ortion of patients whose
care met the chosen standards. Qualitative data were
analysed thematically by the three authors separately,
w ho then met to agree a final coding frame work. T hemes
were ranked accor ding to fr equency of response. Data
from clinics on improvements made as a result of the
EC TAS recommendations were also collected.
Res ults
Table 1 shows questions asked and quantitative results.
Kershaw
et al
Patients’ vie ws on their elec tr oc onvulsive t herapy
original
papers
414

Stand ards o f the quality of car e
In response to the question Were you ac companied to
the ECT clinic by a member of staff?’ 90% of pat ients
who r e sponded to this ques tion (
n
=340 out of 377) said
that they had been, with 78% (
n
=279 out of 358)
responding that they knew the accompanying member of
staff and 70% (
n
=256 out of 368) responding that the
staff member st ayed with them t hroughout the treat-
ment. Additional comments in the spaces after the se
questions were analysed in themes. T he most frequent
theme was that of general praise f or the staff members
and the importance of being accompanied to the clinic
(
n
=28). Patients also commented that it was reassuring
to know the member of staff who accompanied them
(
n
=8), as illustrated in the quotation below.
I was particularly fortunate in being cared for by staff with
whom I had been familiar for years’.
They also responded positively about that per son being
able to stay with t hem throughout the treatment (
n
=8).
In response to a question as to whether they felt
staff were friendly and reassuring 95% of respondents
(
n
=357 out of 377) answered ye s’ and 96% (
n
=360 out
of 375) thought the clinic was clean and comfortable.
In response to the question, ‘How long did you have
to wait before your ECT?’ 68% of patients (
n
=249 out of
368) responde d that they waited for less than 20 min,
11 % (
n
=42 out of 36 8) waited between 20 and 4 0 min,
and 3% (
n
=12 out of 3 68) waited longer than 40 min.
The impact of not having to wait on allaying anxiety was
illustrated by this patient:
[Waiting] ‘Usually 5
-
10 minutes. That was great, usually I
walked straight in which REALLY helped as I was anxious’.
There were 18% (
n
=70 out of 368) of the respondents
who could not rememb er how long they waited. In t he
comments section for this question, the majority of
responses indicated t hat they had little or no wait, or
that they did not feel they had had t o wait l ong.
However, some patients left less positive comments
(
n
=4):
‘There s eemed to be no appointment system therefore we
were oft en waiting quite a long time as everyone was
supposed to arrive at 9:00am.
With regard to c are af ter ECT, 89% of the resp ondents
(
n
=332 out of 372) stated that they were proper ly cared
for immediately after treatment and 88% agreed that the
clinic staff ensured they had made appropriate arrange-
ments for travel and supervision after t he treatment.
Free-text comments in response to the question ‘Please
wr ite down ways in which the aftercare provided could
have been improved’ were positive from 75 respondents,
who stated that care could not be improved; 14
mentioned that they required more personal attention,
wi th 2 mentioning more help wit h disorientation. One
example of a respondent claiming to have experienc ed
poor care is given below:
Left confused and hungry and thirsty till taken back to the
ward’.
There were 7 patients who commented that they would
have appreciated a more comfortable place to rest after
treatment, and 5 mentione d that they wo uld have liked
to have been offered refreshments.
In response to a question asking patients’ views on
how the exp erience could have been improved, 10
patients referred to too much waiting either before or
after treatment; 5 patients commented that they would
have liked more reassurance from staff, and a further 5
stated that they would have appreciated more support
afterwards. There were 133 patients who remarked that
they could not think of anything that could have improved
the experience for them.
In response to the question When you arri ved, were
you introduced to all those who would be present during
your treat ment?’ 65% (
n
=240) of the total 367 respon-
dents indicated that they were and 18% (
n
=66) indicated
that they were not. Eleven patients left additional
comments that t his was reassuring and 2 patient s stated
that they were not introduced to the clinic team, but
would have liked to have been.
Kershaw
et al
Patients’ vie ws on their el ec troc onvulsiv e therapy
original
papers
Table 1. Questions asked and quantitative results
Questions
Yes
n
(%)
No
n
(%)
Partly
n
(%)
Don’t know
n
(%)
Were you accompanied to the ECT clinic by a member of staff? 340 (90.2) 25 (6.6) 3 (0.8) 9 (2.4)
Did the accompanying member of staff stay with you throughout the
treatment? 256 (69.6) 38 (10.3) 10 (2.7) 64 (17.4)
Did you know the member of staff who accompanied you? 279 (77.9) 32 (8.9) 26 (7.3) 21 (5.9)
When you arrived were you introduced to all those who would be
present during your treatment? 240 (65.4) 66 (18.0) 24 (6.5) 37 (10.1)
Did clinic staff check that you still agreed to have ECT before y our
treatment? 215 (78.0) 69 (19.0) 4 (1.1) 76 (20.9)
Were clinic staff friendly and reassuring? 357 (94.7) 2 (0.5) 6 (1.6) 12 (3.2)
Was the clinic clean and comfortable? 360 (96.0) 0 (0) 3 (0.8) 12 (3.2)
Do you think that you were properly cared for immediately after
treatment? 332 (89.2) 6 (1.6) 14 (3.8) 20 (5.4)
[Day patients only] Did clinic staff check that you would b e
accompanied home, have appropriate responsible adult supervision
and were not going to drive a vehicle? 119 (88.1) 6 (4.4) 5 (3.7) 5 (3.7)
415

Pati entso v erall v i e w s
Out of th e 389 respondents 161 (41%) additionally
replied to the open-ended question asking for their
overall views of ECT. Fifty four patients spont aneously
made referenc e to having received good quality of care’
during treatm ent; 35 patients left positive c omments
about staff, the majority relating to humanistic or caring
qualities. Words frequently used in describing clinic staff
were comforting’, reassuring’, ‘kindness’, sympathetic and
support. The attitude of staff members was also praised
-
non- judgemental’, unpatronising’ (
n
=2)
-
as well as
their professionalism (
n
=5).
A rec urrent theme identified from analysis of the
overall v iews’ question was patients’ fear of ECT and
discomfort during the procedure (
n
=22) . A number of
patients commented that their feelings of fear were
lessened or allayed by the support of clinic staff (
n
=8),
and the information they provided (
n
=2):
. . . when I start a course of ECT. At that time the treatment
feels frightening and humiliating: the ECT staff and doctors
have always been r eassuring and professional. The ECT
department at [the] hospital has been excellent!
‘The whole procedure terrified me initially
-
just the
thought of it. But the nursing staff were exc ellent. They
explained everything to me and reassured me, putting me
right at ease’
‘It would be a help to be more informed on the ECT treat-
ment. It would also help to take the fear out of the
treatment.
Staff supporting family members was anot her aspect of
care raised by patients (
n
=6):
All the staff in the ECT unit at [the] hospital are very
friendly, are caring in their approach to each other, their
patients and relatives. No thing is too much trouble and they
ensure that everyone underst ands what is going to happen
‘Staff at ECT clinic very caring and helpful to bot h my wife
and mysel f.
The importance of feeling monitored and safe was
another prominent theme (
n
=6).
I havehad ECT inthepast...andthiswas by far the most
comfortable and reassuring in the use of up-to- date
equipment, sufficient space in case of problems’
‘They have a consultant anaesthetist and an operating
department assistant and a consultant psychiatrist and a
senior house officer who never leaves until all the p atients
are ready to re turn to the wards’.
Less positive responses were left by 17 p atients. Sugg es-
tions for improvement include d: provision of a quiet area
in which to lie down after treatment (
n
=2), an improved
waiting area (
n
=4), more privacy (
n
=3), less waiting
(
n
=2), better information on ECT (
n
=8). One patient als o
commented on feeling pressurised into having more
treatments than the y thought was nec essary and another
felt like they were on a production line’, commenting:
On the whole an unpleasant experience which I found very
degrading. I didnt like the production line type of way it
was done’.
The experience of having to travel to ano ther hospital for
treatment was also described as traumatic (
n
=2), for
example
‘I was transferred to
Y
from my local area due to lack of
funding, this I found very traumatic.
Clinic responses to ECTAS feedback
Feedback from ECTAS member clinics has demonstrated
how advice given during the acc reditation process has led
to improvements in t he quality of care provided to
patients. Example s include increased privacy for patients
waiting for ECT, and improvements in the quality of the
waiting area and post-recovery room:
‘[We] now regularly us e outpatient rooms for individual
consent checks/private waiting areas in accordance with
service user needs. This means that if a patient wants to
have their relative with them whilst waiting for tr eatment,
we are able to offer a private area
‘Waiting areas [have been] made more welcoming e.g.
pro visio n of magazine s, newspap ers, new seats, additional
leaflet rack’
‘[We now have] new soft furnishings for the post-recovery
area’.
Discussion
Strengths and we aknesse s
The main strength of the study was its multicentred
design with a nationwide representation of p atients’
views coming from over half of t he countrys ECT clinics.
A further strength was that alt hough the questionnaires
were distributed by the clinics, the patients were aware
that the data would be analysed independently. The prin-
cipal limitation is that the clinics participated on a volun-
tary basis, and so the data did not come from a
representative sample of all ECT clinic s. Another draw-
back was the inability to calculate the actual number of
patients r eceiving questionnaires from thos e clinics;
hence the response rate could only be estimated. This
modest respons e rate could be due to a number of
factors, for example patients who receive ECT are
severely ill, they may be experiencing cognitive side-
effects and are often elderly, making it more difficult for
them to complete the questionnaire. The sample, there-
for e, may not be representative of all patients. Further
studies could improve the response rate by providing an
independent advocate to assist patients in completing
the questionnaire, and conducting a follow-up mailing.
Main f indings
Overall, the majority of patients who responded reported
a good standard of care. Over 70% of patient s rated
eight of t he nine key standards as hav ing been met. The
nine key standards were rated as having been met by
more than 65% of respondents. These standards referred
to the accompaniment of the patient to the treatment
room by a member of staff, the cleanliness of the clinic,
the friendliness of staff, care immediately after ECT and
waiting times. The standard that was rated as being met
the least was that of the patient being introduced to
everyone present in the ECT suit e (65%).
Kershaw
et al
Patients’ vie ws on their elec tr oc onvulsive t herapy
original
papers
416

The free text section revealed that the perception of
staff having human or caring qualities was very important
to patients, and was mentioned more often than their
technical abilities. ECT was shown to provoke cons ider-
able anxiety in some patients. This may be reduced by
personal attention and reassurance from clinic staff,
confidence in t he safety of the equipment and procedure,
reduced waiting and as much privacy as possible.
The qualitative data also highlighted patients
concerns about the quality of care they received. In a
minority of cases, patients complained about inadequate
care and, more s eriously in a smaller minority, about a
lack of personal attention or lack of care for their disor-
ientation. A few raised concerns about the quality of their
immediate aftercare, including insufficient personal care
and, more specifically, the lac k of a quiet area to lie down
and recover. Discomfort caused by long waiting times
was also mentioned. This finding is consistent w ith the
revised ECTAS s tandard which stipulates that patients
should have to wai t no longer than 30 min prior to
treatment, with an e xplanation being offered if the wait
is for some reason longer (Cresswell
et al
, 2006). Travel-
ling long distances to other hospitals to have ECT was
also found to increase patients’ anxiety about the treat-
ment. In light of the current trend of clinic closur e and
amalgamation, it i s important that clinic staff are aware
of the impact this may have on patients, and offer extra
support where necessary.
Clinics should continue to invol ve family members in
the treatment proces s, if relevant, which helps to reas-
sure both the patient and their family members, who
often share the burden of the illness. This ethic is consis-
tent with the work of Sj˛blom
et al
(2005), who have
emphasised the importance of family involvement in the
treatment of people with mental health problems.
Although most studies investigating patients’ views
about EC T are concerne d with reporting effectiveness
and side-effects, Sienaert
et al
(2005) studied overall
patient satisfaction in a small patient sample recei ving
EC T at on e clinic in Belgium. The r esearc hers also found
high levels of reported anxiety among patients having
EC T, and high levels of satisfaction w ith clinic staff. Their
study indicated that overall satisfaction with ECT was not
related to its effecti veness or lack of side-effects. The
current study adds to the literature in suggesting that
other factors, such as r eassurance about the safety of the
procedure and personal attention from staff, should be
considered when assessing patients satisfaction with
ECT.
Implic ations for prac t ice
Most patients report a high quality of care while having
EC T. Patients, who are often anxious about ECT, are
helped by care and support from staff, reassurance about
the safety of the procedure and personal attention and
care on reco very. In particular, our study highlights the
importance o f providing suitable are as in which patients
can wait before and after ECT, and the need to minimise
waiting times. Patient feedback is crucial to the deliv ery
of improved care. Clinics should seek regular feedback
from patients on their experience of ECT, and use
patients’ vie ws t o continually raise standards of care.
De claration of int erest
All the authors work with the ECT Accreditation Service
at the Royal College of Psychiatrists’ Centre for Quality
Improvement .
Ack nowle dgem ents
We thank all ECTAS member clinics, and Adrian Worrall
for his support and guidance.
References
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National Audit of
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Scotland
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(20 05)
The ECTAccreditation Service
(ECTAS): Standards for the
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(3rd edn). Royal
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*Kerry Ker shaw PhD student, Royal College of Psychiatrists and Goldsmiths
College, Royal College of Psychiatrists’Research andTraining Unit, Standon House,
21Mansell Street, London E18AA, email: psp01kk@gold.ac.uk, Lauren
Rayner ECTAccreditation Service ProjectWorker, Royal College of Psychiatrists’
Research andTraining Unit, London, Robert Chaplin Re search Fellow, Royal
College of Psychiatrists’ Research andTraining Unit, Londo n, and Consultant
Psychiatrist, Oxfordshire & Buckinghamshire NHS Partnership Mental HealthTrust,
Warneford Hospital, Oxford
Kershaw
et al
Patients’ vie ws on their el ec troc onvulsiv e therapy
original
papers
417

10.1192/pb.bp.107.014860Access the most recent version at DOI:
2007, 31:414-417.Psychiatric Bulletin
Kerry Kershaw, Lauren Rayner and Robert Chaplin
electroconvulsive therapy
Patients' views on the quality of care when receiving
References
http://pb.rcpsych.org/content/31/11/414#BIBL
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TL;DR: Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it, however, much needs to be done to improve the practice of ECT and to enhance patients’ satisfaction with the experience of treatment.
Abstract: Objectives. Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts widespread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients. Methods. Extensive electronic and manual searches were conducted to identify all relevant studies on the subject. Results. Seventyfive reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment...

95 citations


Cites background from "Patients' views on the quality of c..."

  • ...Information on attitudes of patients regarding ECT could be extracted from 54 reports (Table IV), four of which had only provided qualitative data (Froede and Baldwin 1999; Koopowitz et al, 2003; Rose et al. 2004; Rajkumar et al. 2007)....

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  • ...…certain as they feel that this trust could actually be emanating from feelings of powerlessness and desperation, which are often refl ected in subjective descriptions of the consent process (Johnstone 1999; Froede and Baldwin, 1999; Koopowitz et al. 2003; Philpot et al. 2004; Rajkumar et al. 2007)....

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  • ...…impairment, qualitative data and subjective accounts of patients also provided graphic accounts of memory diffi culties and their psychosocial consequences (Froede and Baldwin 1999; Johnstone, 1999; Koopowitz et al, 2003; Philpot et al, 2004; Rose et al. 2004; Rajkumar et al. 2007; Vamos 2008)....

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  • ...Subjective accounts of patients also refl ected this favourable perception of ECT (Koopowitz et al, 2003; Rajkumar et al. 2007)....

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  • ...In addition, fear of ECT was commonly described in several subjective accounts (Johnstone 1999; Froede and Baldwin 1999; Koopowitz et al. 2003; Philpot et al. 2004; Rajkumar et al 2007)....

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Journal ArticleDOI
TL;DR: Electroconvulsive therapy–related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management.
Abstract: BackgroundA significant proportion of electroconvulsive therapy (ECT)–treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is

33 citations

Journal ArticleDOI
TL;DR: The weight of the evidence supported the notion that patients undergoing ECT and their relatives are well disposed towards it, but the lacunae in treatment highlighted by this review and extreme variations in practice suggest that much more needs to be done to improve the practice of ECT in developing countries, to enhance patients' and relatives' satisfaction with the treatment.
Abstract: Objectives Although electroconvulsive therapy (ECT) is used frequently in many developing countries, investigations of patients' awareness and perceptions of the treatment are rare. This review attempted to pool the research evidence in this area from developing countries. Methods Electronic searches of databases using relevant keywords were supplemented by extensive manual checking of cross-references and other sources. Results Sixteen such reports were found suitable for inclusion. The limited data showed that patients were usually poorly informed about ECT, which was partly attributable to unsatisfactory pretreatment explanations received by approximately two thirds of the recipients. About a third also reported deficiencies in the process of consent, including a sense of coercion. Fear of ECT was reported by a significant percentage (36%-75%). Distressing adverse effects were frequent; memory impairment (25%-95%) being the most common one. Despite these problems, most studies found that most patients perceived ECT to be helpful and had positive views about it. Simultaneously, a sizeable percentage (10%-32%) was quite critical of ECT. In contrast, relatives of patients were invariably better aware, more satisfied with the experience, and had more favorable attitudes toward ECT. Conclusions Overall, the weight of the evidence supported the notion that patients undergoing ECT and their relatives are well disposed towards it. However, the lacunae in treatment highlighted by this review and extreme variations in practice of ECT suggest that much more needs to be done to improve the practice of ECT in developing countries, to enhance patients' and relatives' satisfaction with the treatment.

30 citations

Journal ArticleDOI
TL;DR: Most patients, and particularly their relatives, were satisfied with ECT, but there were several areas of concern including the fear of ECT), lack of information, and the possibility of enduring cognitive problems.
Abstract: ObjectivesDespite substantial proof of its efficacy, there has been little systematic research of satisfaction with electroconvulsive therapy (ECT) among patients or their relatives. This study sought to evaluate satisfaction with the treatment among patients who had undergone ECT and their relative

27 citations


Cites background from "Patients' views on the quality of c..."

  • ...Range 3Y22 Rate of improvement following ECT (index-treatment episode)† 975% 4 (8) 51%Y75% 37 (74)...

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  • ...I feel downhearted and low 29 (58) 19 (38) 2 (4) I feel comfortable in groups 2 (4) 14 (28) 34 (68) I feel tired and worn out most of the time 34 (68) 12 (24) 4 (8) Subscale scores, mean T SD 20....

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  • ...I have (my relative has) more energy since my (his/her) ECT treatment 5 (10) 17 (34) 28 (56) 4 (8) 4 (8) 42 (84)§...

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  • ...I (my relative) was treated with respect by the people in the room where I (he/she) received ECT V 19 (38) 31 (62) 1 (2) 4 (8) 45 (90)‡...

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  • ...I (and my relative) received the right amount of information about ECT 13 (26) 22 (44) 15 (30) 40 (80) 6 (12) 4 (8)‡...

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Journal ArticleDOI
TL;DR: This study examines the knowledge and attitude of patients and their relatives towards ECT in a major hospital in north India and is likely to give direction for further research with refined methodology.
Abstract: Background: It is believed that people lack sound knowledge and appropriate attitude towards electroconvulsive therapy (ECT). However, very little systematic research has gone into this area. Aim: To examine the knowledge and attitude of patients and their relatives towards ECT. Methods: A 16-item questionnaire with satisfactory face validity and content validity was constructed and translated into Hindi. It was then administered to 89 patients and 83 relatives attending the psychiatry services in a major hospital in north India. Results: More than 65% of the respondents in both the groups-patients as well as relatives-gave correct responses such as ECT is life saving, many times it causes temporary but not permanent memory impairment and that ECT is not a non-scientific treatment. There was non-significant disagreement between the two groups. Conclusion: The study is a preliminary exploratory one and is likely to give direction for further research with refined methodology.

26 citations

References
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Journal ArticleDOI
TL;DR: A systematic overview and meta-analysis of randomised controlled trials and observational studies for the efficacy and safety of electroconvulsive therapy with simulated ECT, ECT versus pharmacotherapy, and different forms of ECT for patients with depressive illness found ECT is an effective short-term treatment for depression.

1,321 citations

Journal ArticleDOI
19 Jun 2003-BMJ
TL;DR: The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.
Abstract: Objective To ascertain patients’ views on the benefits of and possible memory loss from electroconvulsive therapy. Design Descriptive systematic review. Data sources Psychinfo, Medline, Web of Science, and Social Science Citation Index databases, and bibliographies. Study selection Articles with patients’ views after treatment with electroconvulsive therapy. Data extraction 26 studies carried out by clinicians and nine reports of work undertaken by patients or with the collaboration of patients were identified; 16 studies investigated the perceived benefit of electroconvulsive therapy and seven met criteria for investigating memory loss. Data synthesis The studies showed heterogeneity. The methods used were associated with levels of perceived benefit. At least one third of patients reported persistent memory loss. Conclusions The current statement for patients from the Royal College of Psychiatrists that over 80% of patients are satisfied with electroconvulsive therapy and that memory loss is not clinically important is unfounded.

425 citations


"Patients' views on the quality of c..." refers background in this paper

  • ...In recent years there has been much interest in the views and experiences of patients who have undergone ECT (Rose et al, 2003; Philpot et al, 2004), although this has not been focused on patients’ perception of the quality of care they received....

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Journal ArticleDOI
TL;DR: Some evidence was found that psychosis predicted better response to ECT, and ECT was shown to be superior to medication and simulated ECT.
Abstract: Recently published controlled studies comparing electroconvulsive therapy (ECT) with other treatments for depression offer the opportunity to perform a meta-analysis of ECT in depression. Fifteen studies were identified which fulfilled the inclusion criteria. From these controlled trials, 20 effect sizes of ECT were calculated. The speed of action during the course and the efficacy after a full course of ECT were explored. The efficacy of sine wave and brief pulse machines were compared. The comparison between ECT and four other comparative treatments was made. Predictive variables were explored using homogeneity tests. ECT was shown to be superior after a full course. The funnel plot showed the absence of publication bias. There was no exaggeration of effect size in the lower quality trials. No evidence was found for a superior speed of action of ECT or for a difference in efficacy between sine wave and brief pulse stimulation. ECT was shown to be superior to medication and simulated ECT. Some evidence was found that psychosis predicted better response to ECT.

221 citations

Journal ArticleDOI
TL;DR: This is the third large-scale audit in the past 20 years and compares the practice of electroconvulsive therapy in England and Wales with the standards derived from the Royal College of Psychiatrists' 2nd ECT handbook.
Abstract: BACKGROUND This is the third large-scale audit in the past 20 years and compares the practice of electroconvulsive therapy (ECT) in England and Wales with the standards derived from the Royal College of Psychiatrists' 2nd ECT handbook. METHOD Facilities, equipment practice, personnel and training were systematically evaluated during visits to all ECT clinics in the former North East Thames and East Anglia regions and Wales. All other English ECT clinics were surveyed with a postal questionnaire. Information was obtained for 184 (84%) of the 220 ECT clinics identified. RESULTS Although some aspects of ECT administration had improved since the last audit in 1991, overall only one-third of clinics were rated as meeting College standards. Only 16% of responsible consultants attended their ECT clinic weekly and only 6% had sessional time for ECT duties. Fifty-nine per cent of all clinics had machines of the type recommended by the College and 7% were still using machines considered outdated in 1989. Only about one-third of clinics had clear policies to help guide junior doctors to administer ECT effectively. CONCLUSIONS Twenty years of activity by the Royal College of Psychiatrists and three large-scale audits have been associated with only modest improvement in local practice.

63 citations

Journal ArticleDOI
TL;DR: It is argued that nurses should carefully consider whether and how to involve family members in care and improved communication between nurses, patients and families could be a way to resolve the double-bind situation.
Abstract: Aims. The aim of this study is to examine nurses’ view of the family in psychiatric care. Background. The families of people who are mentally ill carry a heavy burden. Research has shown that they experience sorrow, shame and guilt. They are often involved in informal caring and there is evidence of families playing an important role in the recovery of the patient. In spite of this, a great deal could still be made to create more family-oriented care. This development depends to a large extent on nurses’ view of involving families in the care and the perceived value of family-oriented work. Method. Four focus groups, with four to six carers in each group, were conducted. The recorded focus groups lasted 75–90 minutes and the data were transcribed and interpreted using content analysis. Results. The results present four themes: compassion for and understanding of close relatives, the carer as the recipient of negative feelings, difficulties and dilemmas in the meeting with close relatives and preconceptions of mental illnesses in the family and in society. The results were interpreted as meaning that the carers found themselves in something that can be described as a double-bind situation. Conclusion. From analysis and interpretation, the conclusion is drawn that improved communication between nurses, patients and families could be a way to resolve the double-bind situation. Relevance to clinical practice. To promote family health and also improve things for the patient, it can be argued, from the results of this study, that nurses should carefully consider whether and how to involve family members in care.

57 citations

Frequently Asked Questions (2)
Q1. What are the contributions in "Patients’ views on the quality of care when receiving electroconvulsive therapy" ?

In this paper, the nine key standards set by ECTAS relating to quality of patient care were rated as having been met by 65 % or more respondents. 

Further studies could improve the response rate by providing an independent advocate to assist patients in completing the questionnaire, and conducting a follow-up mailing. The current study adds to the literature in suggesting that other factors, such as reassurance about the safety of the procedure and personal attention from staff, should be considered when assessing patient ’ s satisfaction with ECT.