A Brief Cognitive Task Intervention for NHS Staff Affected by COVID-19 Trauma (GAINS-2 Study)

Study Overview
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Brief Summary
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Frontline healthcare staff are frequently exposed to traumatic events at work (e.g., witnessing patients die), amplified by the COVID-19 pandemic. A significant proportion experience intrusive memories of these events that pop suddenly into mind: they can disrupt functioning and can contribute to post-traumatic stress disorder. Previous research has shown that a brief behavioural intervention can reduce the number of intrusive memories after a traumatic event. In this study we will test the effect of a digital imagery-competing task, a digital music-listening task and treatment as usual (TAU) for National Health Service (NHS) staff with intrusive memories of work-related traumatic events from the pandemic. We test the effect on the number of intrusive memories (primary outcome), and other clinical symptoms (PTSD, anxiety, depression, and insomnia), in addition to work functioning, general functioning and quality of life (secondary outcomes). Intervention feasibility, acceptability and implementation will also be explored (additional outcomes). We will recruit approximately 150 NHS staff (via the Intensive Care Society, social media and direct advertising by NHS Trusts) with intrusive memories of traumatic events experienced during the COVID-19 pandemic. The study is funded by the Wellcome Trust (223016/Z/21/Z).

Detailed Description
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A statistical analysis plan will be prepared prior to the first interim analysis using Bayesian analyses for statistical inference. Regular monitoring will be performed by P1vital Products to verify that the study is conducted, and data are generated, documented and reported in compliance with the protocol, GCP and the applicable regulatory requirements. Quality assurance representatives from the Sponsor may carry out an audit of the study in compliance with regulatory guidelines and relevant standard operating procedures.

Official Title
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A Randomised Controlled Trial of a Brief Cognitive Task Intervention to Support NHS Staff Experiencing Intrusive Memories of Traumatic Events From Working in the COVID- 19 Pandemic.

Conditions
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Intrusive Memories of Traumatic Event(s)

Intervention / Treatment
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* Behavioral: Brief digital imagery-competing task
* Behavioral: Brief digital music-listening task
* Other: Treatment As Usual


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 18 or above. Able to read, write and speak in English. Worked in a clinical role with COVID-19 patients in the NHS during the COVID-19 pandemic. Experienced at least one traumatic event related to their clinical work during the COVID- 9 pandemic meeting criterion A of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria for Post-Traumatic Stress Disorder (PTSD): exposure to actual or threatened death, serious injury, or sexual violence by directly experiencing the traumatic event(s) or witnessing, in person, the event(s) as it occurred to others. Experience intrusive memories of the traumatic event(s). Experienced at least three intrusive memories in the week prior to screening. Have internet access. Willing and able to provide informed consent and complete study procedures Willing and able to be contacted by the research team during the study period. Have not taken part in a previous study of this intervention from this research team Exclusion Criteria: • Have fewer than three intrusive memories during the run-in week.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Brief digital imagery-competing task<br>Access to a brief digital imagery-competing task for 24 weeks (first 4 weeks with optional researcher support). | Behavioral: Brief digital imagery-competing task<br>* First session guided by a researcher: A memory cue followed by playing a computer game with mental rotation instructions. Option to engage in self-administered/guided sessions after the first session.<br>|
| Experimental: Brief digital music-listening task<br>Access to a brief digital music-listening task for 24 weeks (first 4 weeks with optional researcher support). | Behavioral: Brief digital music-listening task<br>* First session guided by a researcher: Information about the composer's music followed by listening to classical music. Option to engage in self-administered/guided sessions after the first session.<br>|
| Experimental: Treatment As Usual<br>Access to routine care that participants would otherwise receive if having intrusive memories of traumatic events for 24 weeks. | Other: Treatment As Usual<br>* Access to routine care that participants would otherwise receive if having intrusive memories of traumatic events.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of intrusive memories of traumatic event(s) | Number of intrusive memories of traumatic event(s) recorded by participants in a brief daily online diary for 7 days. | Week 4 (all arms) controlling for run-in/baseline week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of intrusive memories of traumatic event(s) | Number of intrusive memories of traumatic event(s) recorded by participants in a brief daily online diary for 7 days. | Weeks 12 and 24 (all arms) controlling for run-in/baseline week | 
| PTSD Checklist for DSM-5 (PCL-5) | This 20-item measure assesses symptoms of PTSD over the last week. Items are rated on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Scores are summed to give a total severity score (ranging 0 to 80). | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Sleep Condition Indicator (SCI) | This 8-item scale measures sleep problems against the DSM-5 criteria for insomnia disorder. Item responses are each scored 0-4, with scores from 0 to 2 indicating threshold criteria for insomnia disorder. Total score ranges 0-32, with a higher score indicating better sleep. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Generalised Anxiety Disorder 2-item scale (GAD-2) | This 2-item short-form self-report measure assesses symptoms of anxiety. Items are rated for how often they have bothered the respondent over the last two weeks, from 0 (not at all) to 3 (nearly every day). Total score is the sum of both items and ranges from 0 to 6. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Patient Health Questionnaire 2-item version (PHQ-2) | This 2-item short-form self-report measure assesses symptoms of depression. Items are rated for how often they have bothered the respondent over the last two weeks, from 0 (not at all) to 3 (nearly every day). Total score is the sum of both items and ranges from 0 to 6. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Scale of Work Engagement and Burnout (SWEBO) | This 19-item self-report measure assesses work engagement and burnout. The work engagement subscale consists of 10 items assessing three dimensions (vigour, attentiveness, dedication). The burnout subscale consists of 9 items assessing three dimensions (exhaustion, disengagement and inattentiveness). Respondents rate how often they have felt each descriptive in the past two weeks, from 1 (not at all) to 4 (all the time). The mean score is calculated for each subscale. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Sickness absence | Single item assessing self-reported number of sick days taken from work in the last 4 weeks. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Intention to leave job | 3 items assess participants' intention to leave their job e.g. I think a lot about leaving the job, each rated from 1 (strongly agree) to 5 (strongly disagree). The total score ranges 3 to 15, with a lower score indicating stronger intention to leave the job. | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| 5-level European Quality of Life 5 Dimension (EQ-5D-5L) | The 5-level version of the EuroQol-5D (EQ-5D-5L) is a brief measure for assessing general quality of life and health status. Items assess mobility, self-care, usual activities, pain/discomfort and anxiety/depression each on a 5-point scale. 5 items are scored on a 5-point ordinal scale from 'no problem' (1) to 'highest level of problems' (5). Respondents also rate their overall health today from 0 (the worst health you can imagine) to 100 (the best health you can imagine). Scores are analysed separately (not summed). | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| World Health Organization Disability Assessment Schedule 12-item version (WHODAS 2.0) | The 12-item, self-report version of the WHODAS 2.0 will be used to assess difficulties in relation to the impact of intrusive memories. Respondents rate how much difficulty they have had in each area in the past 30 days, from 0 (none) to 4 (extreme or cannot do). The overall score is calculated as a percentage of the maximum possible score (i.e., 48 points). | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) | 
| Intrusive memory ratings | The 9-item questionnaire assesses a number of intrusive memories characteristics. These characteristics include frequency (7-point categorical response from 'never' to 'many times a day'); distress (0=not at all to 10=extremely); disruption to concentration (0=not at all to 10=extremely); interference with what you were doing (how much (0=not at all to 10=extremely) and for how long (6-point categorical response from '<1min' to '>60mins')); impact on work functioning (how much (0=not at all to 10=extremely) and in what ways (open text response)); impact on functioning in other areas of life (how much (0=not at all to 10=extremely) and in what ways (open text response)). | Baseline, 4 weeks, 12 weeks and 24 weeks (all arms) |