JMIR Publications

ABSTRACT

Background:

Psychological therapies are effective for several physical and mental health problems, but their overall effectiveness has not improved for over forty years. Technology development has applied the approach of benchmarking effectiveness to evaluate the combined impact of multiple adaptations, compared to best practice outcomes. However, this approach has been used little in psychological therapy research, when the pace of digitally enhanced adaptations may mean this approach adds value to the field.

Objective:

This study evaluated the clinical effectiveness and efficiency of a psychological therapy service model that employed multiple, digitally enhanced adaptations across the care pathway for those living with and beyond cancer, experiencing moderate-to-severe depression and/or anxiety. Service outcomes were benchmarked against an internationally recognized standard of best practice in the National Health Service Talking Therapies (NHS TT) program.

Methods:

Between 20th January 2022 and 31st March 2026, adults with a cancer diagnosis and significant anxiety and/or depression were referred to the East Midlands Cancer Alliance Centre for Psychosocial Health (EMCA CPH), The service incorporated seven adaptations to the care pathway to improve outcomes: (1) training and supervision of referrers; (2) a digitally enhanced therapy preparation intervention that also included (3) personalized smart-messaging reminders of patients’ motivations for therapy attendance, and (4) accommodation of patient preferences; (5) Routine Outcome Monitoring that applied dynamic algorithm-based predictions of patient prognosis to alert therapists to patients who may not improve; (6) use of session recordings to support therapists to deliberately practice their individualized skill growing edges, and (7) a digitally supported relapse prevention intervention that extended beyond discharge. Employing a longitudinal, time-series design, clinical outcomes for depression and anxiety (PHQ‑9, GAD‑7) were analysed using NHS TT definitions of reliable improvement, reliable recovery, and reliable deterioration. EMCA CPH performance was benchmarked against the 145 NHS TT services reporting 2024–25 data. Logistic regressions were used to identify any predictors of reliable improvement.

Results:

Of 639 patients referred to EMCA CPH, 356 met criteria for the service and 282 (79%) provided follow-up data. The evaluated service achieved rates of reliable improvement (241/282, 85.5%) and recovery (166/277, 59.9%), above the 99th and 97th centiles respectively compared to benchmarked standard NHS TT services. The reliable deterioration rate reported (7/282, 2.5%) was lower than all 2024-25 NHS TT services. More severe baseline depression (OR=0.89, 95% CI [0.83, 0.94], P<.001) and longer waiting times (OR=0.99, 95% CI [0.98, 0.99], P=.012) predicted lower likelihood of reliable recovery.

Conclusions:

Psychological therapy provided by EMCA CPH, employing a range of digitally supported personalization methods and pathway innovations, obtained greater effectiveness and efficiency compared to NHS TT services. Further research is required to determine whether the personalization methods contributed to this improved performance or if it was due to other factors.