Information about PAT

Why was the PAT developed?

The PAT was developed in response to repeated calls from governments, clinicians, researchers and social commentators to improve standards of care in the cosmetic sector and to safeguard prospective patients/clients with psychological vulnerabilities.

How has the PAT been developed?

The PAT has been developed by world leaders in the psychology of appearance (see about us). In the absence of longitudinal data in this sector, it is not yet possible to develop an authoritative, psychometrically validated screening tool capable of detecting the full range of psychological vulnerabilities identified in recent systematic reviews as being associated with an increased risk of sub-optimal psychological outcomes following treatment. Accordingly, this work stream has focused on the ‘next-best-thing’. Extending research and development work underpinning the development of the RoFCAR (a validated scale designed to assess the psychological status of patients/clients seeking plastic & reconstructive surgery, published in 2010 but now outdated), the PAT is an evidence-based, clinically relevant patient assessment framework.

A pilot study conducted in the UK & Australia involving 15 surgeons and practitioners & 100 patients/clients has confirmed that the PAT is fit for purpose.  Clinicians reported that the tool was easy to use and provided important insights into clients’ psychological readiness for treatment together with appropriate ‘in-house’ management strategies to minimize the risks of sub-optimal outcomes. Clients were positive about its use. They felt ‘heard’ by clinicians and were pleased that clinicians had taken the trouble to explore their motivation for treatment as well as their aspirations for treatment.

How is the PAT structured?

The PAT is an evidence based clinical aid designed to structure the assessment of prospective clients wishing to undergo aesthetic treatment. Suitable for use in cosmetic surgery and/or cosmetic practice settings, the PAT comprises 13 questions that guide the initial assessment interview between the clinician and client. These questions cluster around 6 areas of psychological vulnerability (including, but not limited to, Body Dysmorphic Disorder) that have been linked through evidence to an increased risk for poorer psychological outcomes following aesthetic treatment.

How does the PAT work?

Client responses are recorded on the online system during the assessment interview by the clinician. At the conclusion of the interview, the system provides the clinician with summary of the client’s relative level of risk in key areas of vulnerability, together with suggestions for reducing these risks as part of an appropriate treatment management plan for the patient. The client’s responses are downloaded by the clinician from the PAT online system at the end of the assessment process in a form designed to form part of the client record.

Why a face-to-face approach

When assessing the suitability of clients for treatment, there are several disadvantages associated with questionnaires completed remotely. Misleading responses may result from the sharing of allegedly ‘correct’ answers via social or news media, the intentional manipulation of answers by a client keen to maximise the chances of receiving treatment, or pressure on the client from third parties to answer in a particular way. In addition, the self-completion of a battery of measures is challenging for those with lower levels of health literacy. A reliance on client self-completion measures distances the practitioner from an understanding of the psychological factors driving the client’s request for treatment.

Face-to-face approaches to assessment offer the opportunity for a richer, more flexible interchange between the practitioner and client, encouraging a more honest and open discussion. The PAT facilitates a shared understanding of the client’s goals and expectations, maximising the chances of positive outcomes for all parties.

Clients seeking cosmetic procedures are motivated to a greater extent by a psychosocial agenda, rather than by medical need. The PAT (& associated training) expands practitioners’ existing medical expertise, enabling them to better meet clients’ needs and increasing the likelihood of satisfaction with treatment.

Face-to-face assessment has the potential to drive up standards of care in the cosmetic sector, promoting client involvement in treatment decision-making and in the process of achieving informed consent.

Is the PAT a psychometrically validated screening tool?

Designed to address acknowledged weaknesses inherent in conventional patient-self-completed measures, the PAT has been constructed as a clinical aid rather than a psychometrically validated screening tool. Developed by leading researchers and clinicians in the field, and informed by expert panels of surgeons, clinicians and researchers at each stage of development, each of the 13 questions is derived from a clear trail of published evidence and from a ‘parent’ scale, the RoFCAR with an established psychometric profile. The PAT includes screening questions for BDD recommended by the UK’s National Institute for Health & Care Excellence in addition to questions exploring other key areas of psychological vulnerability linked in research to an increased risk of poorer post-treatment outcomes.

How does the PAT help me to manage my clients appropriately?

Following completion of the assessment questions, client responses are immediately summarised for the practitioner in relation to three levels of potential risk (low; raised; high) for undesirable outcomes following treatment. In cases of raised or high risk, suggestions for appropriate management are provided. The system also generates evidence-based information prescriptions appropriate for client use during a cooling-off period or two stage consultation process, if appropriate. The output from the PAT offers the basis for a referral for specialist psychological assessment, if necessary.

Is any training available for clinicians wanting to use the PAT?

Yes. Users of the PAT are required to complete a Companion Module explaining the rationale & evidence base for the tool. This Module also provides practical tips to support the psychological assessment and management of the client and information to facilitate the implementation of new ways of working. A series of downloadable resources for clinicians and clients are also provided. Further training modules relevant to the psychology of the cosmetic & reconstructive surgery patients are also available to users of the PAT and to non-users. These modules are suitable for a range of professional groups working in the sector (See Education).