A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Abstract

Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

Adaptations to mindfulness-based interventions for neurological impairment: The SMALL PROMPTS approach.

“…A three-stage modified DELPHI method was used (Coulter et al, 2016; de Meyrick, 2003): Phase 1 was undertaken between May 2018 and September 2019; and Phases 2 and 3 between January 2021 and June 2021. The DELPHI method is an iterative method for developing consensus of expert opinions (de Meyrick, 2003) and has been previously applied to health and psychological research including recently the application of mindfulness-based cognitive therapy (Williams et al, 2021). In the present DELPHI study design, an a priori criterion of three rounds was set (following Trevelyan & Robinson, 2015): Round 1 consisted of a qualitative interview design employing a semistructured interview schedule, whereby data was analyzed inductively using thematic analysis (Braun & Clarke, 2021) to develop recommendations for adapted practice.…”