Patient preference in psychological treatment and associations with self-reported outcome: national cross-sectional survey in England and Wales
Open accessAbstract
BACKGROUND: Providers of psychological therapies are encouraged to offer patients choice about their treatment, but there is very little information about what preferences people have or the impact that meeting these has on treatment outcomes. METHOD: Cross-sectional survey of people receiving psychological treatment from 184 NHS services in England and Wales. 14,587 respondents were asked about treatment preferences and the extent to which these were met by their service. They were also asked to rate the extent to which therapy helped them cope with their difficulties. RESULTS: Most patients (12,549-86.0 %, 95 % CI: 85.5-86.6) expressed a preference for at least one aspect of their treatment. Of these, 4,600 (36.7 %, 95 % CI: 35.8-37.5) had at least one preference that was not met. While most patients reported that their preference for appointment times, venue and type of treatment were met, only 1,769 (40.5 %) of the 4,253 that had a preference for gender had it met. People who expressed a preference that was not met reported poorer outcomes than those with a preference that was met (Odds Ratios: appointment times = 0.29, venue = 0.32, treatment type = 0.16, therapist gender = 0.32, language in which treatment was delivered = 0.40). CONCLUSIONS: Most patients who took part in this survey had preferences about their treatment. People who reported preferences that were not met were less likely to state that treatment had helped them with their problems. Routinely assessing and meeting patient preferences may improve the outcomes of psychological treatment.
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Other studies have shown that accommodating patient treatment can influence treatment outcomes.
“Other studies have shown that accommodating patient treatment can influence treatment outcomes (Adamson et al., 2008; Mergl et al., 2011; Williams et al., 2016).”
From Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial (2021) · cites this paper as Williams et al., 2016
The Discussion reports that patients whose preferences were not adequately accommodated were less likely to say therapy had helped them. The Conclusions explicitly say the survey cannot establish a causal relationship, so it supports an association with self-reported helpfulness, not a demonstrated influence on treatment outcomes. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMost people had at least one preference regarding their treatment, such as venue, time of day, gender of therapist, language, and type of therapy.
“In a national survey conducted in England and Wales, Williams et al. (2016) found that most people had at least one preference regarding their treatment, such as the venue where treatment was delivered, the time of day of appointments, gender of the therapist, language in which the treatment was delivered and type of therapy.”
From Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial (2021) · cites this paper as Williams et al., 2016
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“Additionally, based on previous findings that age (Petronzi and Masciale, 2015; Williams et al., 2016), gender (Furnham and Swami, 2008; Ogunfowora and Drapeau, 2008; Liddon et al.”
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“Als entscheidungsrelevanter Faktor wird nach der Suche, ähnlich wie bei der Studie von Williams et al. (2016), die „Alltagskompatibilität“, z. B. im Vergleich zu „zwischenmenschlichen Komponenten“, priorisiert.”
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“Whether being able to choose between types of self-management interventions can in fact impact outcome remains to be seen, but people’s preference for treatment type, for example, type of psychotherapy vary [34,35], and user input does suggest that personal choice can increase motivation to engage in self-management,…”
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“Advantages to self-selection of psychological therapies include enhanced sense of autonomy and control/agency; engagement in therapy; and tailoring to individual needs and preferences [18, 19].”
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“A NAPT study shows that patients experience more negative effects in psychological treatment when their treatment preferences are not satis fi ed (Williams et al., 2016).”
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“Patients in the National Health Service in the United Kingdom who did not have their preferences for treatment met reported less benefit from psychotherapy than patients who had their preferences met (Williams et al., 2016).”
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“6% to 87%) is particularly striking, and accords with previous findings [15].”
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“These investigations highlight significant impacts, such as reduced dropout rates and enhanced effectiveness (Lindhiem et al., 2014; McHugh et al., 2013; Swift & Callahan, 2009; Umar et al., 2012; Williams et al., 2016).”
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“Studies fi nd that patients are more likely to adhere to treatment recommendations and have good clinical outcomes if they consider the intervention acceptable (Fisher et al., 2006; Hommel et al., 2013; Williams et al., 2016).”
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“In another larger national survey, the reverse relationship was also revealed with participants reporting less favourable outcomes where preferences for mental health treatment were not met (Williams et al. 2016).”
Evidenzbasierte Psychotherapie bei Abhängigkeitserkrankungen
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Online art therapy groups for fibromyalgia: a pilot project.
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“However, an important element in psychological treat-ment outcomes is patient’s choice (Williams et al., 2016), which supports the need for more options.”
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“Third, recent findings suggest that service users whose preferences for psychological interventions are not met are less likely to report meaningful therapeutic gains, and this is likely to impact upon their future engagement (Williams et al., 2016).”
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“The benefits to self-selection of psychological therapies include enhanced sense of autonomy (Hinckley & Jayes, 2023); engagement in therapy and ability for the stroke clinician to tailor therapy to individual needs (Williams et al., 2016).”
An Analysis of Psychiatric Workforce Distribution in the Philippines
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Prediction of the Side Effects Perceived by Therapists in Psychotherapy (Preprint)Preprint
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Do NHS talking therapies services and couple therapy for depression have a relationship problem?
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Treatment experiences and preferences of British South Asians living with recurrent depression
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“Despite the evidence, service users continue to report dissatisfaction with the decision making process [22,23].”
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- Authors
- Williams, R., Farquharson, L., Palmer, L., Bassett, P., Clarke, J., Clark, D. M., & Crawford, M. J.
- Affiliations
- Imperial College London (GB)
- Royal Holloway University of London (GB)
- Royal College of Psychiatrists (GB)
- University of Oxford (GB)
- Corresponding author
- Crawford, Mike J.
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2016-01-15
- Volume
- 16
- Issue
- 1
- Pages
- 4-4
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC4714467
- OpenAlex
- W2233524645
- Cited by
- 76
- References
- 26
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 11 · 2023: 11 · 2022: 6 · 2021: 12 · 2020: 10 · 2019: 9 · 2018: 4 · 2017: 2 · 2016: 2
- FWCI
- 7.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion, cc-by)
- Funders
- NHS England and the Welsh Government
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- patient preferences, psychotherapy, treatment selection, patient satisfaction, NHS mental health services, help-seeking
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Cross-Sectional Studies, England, Female, Health Surveys, Humans, Male, Middle Aged, Psychotherapy, Wales, Treatment Outcome, Young Adult, Patient Preference, Self Report
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