Implementing group metacognitive therapy to improve mental health in NHS cardiac rehabilitation: the PATHWAY beacons study of adoption, adherence and data capture

Aims Anxiety, depression, and post-traumatic stress symptoms are common in cardiac rehabilitation (CR) patients. Group metacognitive therapy (MCT) alongside CR can significantly improve such symptoms compared to usual care. We aimed to conduct the first implementation study of group-MCT in NHS CR services. The objectives were: 1. Establish sites and assess levels of adoption; 2. Revise and pilot data capture via national auditing systems to assess MCT attendance and uptake; 3. Assess site-level MCT-adherence under roll-out conditions. Methods A mixed-methods study evaluated implementation of group-MCT in routine care in CR services. Services across England were recruited as early adopters and staff were trained. The National Audit of Cardiac Rehabilitation (NACR) database was modified to collect and assess performance of group-MCT data capture. Five implementation outcomes were assessed; uptake and adherence, data-capture and quality, patient characteristics, site-level of adoption, and treatment adherence. Results Twenty-six courses of group-MCT were delivered across six services, with an average of 4.3 courses per site and 131 patients receiving treatment. 82.4% of patients attended at least four sessions. Five services met all outcomes and were classed as green; one failed on one criterion and was rated amber. Data capture worked but with some minor discrepancies. Levels of intervention adherence were excellent, with high consistency across sites and time. Conclusions We established six sites meeting our recruitment threshold and demonstrated satisfactory data capture on MCT attendance and uptake via national auditing systems. Five out of six sites met all adoption criteria. Site level adherence and compliance was excellent at 86.7%. Wider-scale adoption could improve access to evidence-based psychological therapy and enhance outcomes across the 188 CR-services in England.