Post on 27-Jan-2023
Efficacy of a Brief Nurse-‐led Psychosocial Interven9on for Cancer
Pa9ents in Singapore
R Mahendran, HA Lim, J Chua SE Lim, EH Kua Dept of Psychological Medicine, Na9onal University Health System, Dept of Psychological Medicine, Yong Loo Lin School of Medicine
Na9onal University of Singapore, Na9onal University Cancer Ins9tute, Singapore
Background
• Distress and other psychological issues are common amongst pa9ents with cancer
• Pa9ent preference for informal nurse-‐interac9ons
• Could effec9ve nurse-‐interac9ons be facilitated?
Background
• Communica9on skills not always op9mal (Fallowfield & Jenkins, 1999)
• Low self-‐efficacy in dealing with emo9onal issues (Parle, Maguire & Heaven 1997)
• Introduc9on of a Training Program at Na9onal University Cancer Ins9tute, Singapore (NCIS)
Training Program for Nurses at NCIS
• Introduce psychosocial aspects of cancer care
• Teach early iden9fica9on of psychological symptoms
• Enhance communica9ons skills and counseling techniques
Format of Training Program • Large group didac9c session
– Introduc9on of screening tools such as Distress Thermometer, Symptoms of distress, anxiety and depression
– Case presenta9ons – Guided through experien9al relaxa9on strategies such as Progressive Muscle Relaxa9on, Deep Breathing Exercises
• Small Group – Worked through case scenarios, role-‐play and facilitator-‐led discussions
• Reading Materials
Effec9veness of the Training Program
• Knowledge, A\tudes and Prac9ce Behaviors of Nurses assessed pre-‐, post-‐training, at six weeks and 12 weeks.
• Applied knowledge and prac9ce behaviors in providing psychosocial care and sustained at 6 weeks but a slight dip at 12 weeks
Knowledge, A,tudes and Prac4ce Behaviors (KAPb) of Nurses and the Effec4veness of a Training Program in Psychosocial Cancer Care. R Mahendran, J Chua, CX Peh, HA Lim, E NK Ang, SE Lim, EH Kua. Suppor4ve Care in Cancer. 2014.
Selec9on of Senior Nurses to Provide Brief Psychosocial Interven9ons
• Nursing decision – nurse managers, some with counseling training, aaended Clinical teaching rounds and Psychotherapy teaching rounds with the Dept of Psychological Medicine
• On-‐going Training and review of problem cases
• Support from Clinical Psychologist and Psychiatrist
Nurse-‐led Psychosocial Interven9ons • Twenty minute face-‐to-‐face sessions at first visit, monthly for 3 months
then bimonthly for six months.
• Screening for Distress for all new cases and follow-‐up – Iden9fica9on of problems (DT Problem List) – HADS Ques9onnaire
• Psycho-‐educa9on on for physical symptoms, sleep, diet, lifestyle and ac9vi9es; distress, anxiety and depression symptom recogni9on; Cogni9ve and behavioral relaxa9on techniques
• Cancer-‐Line – Referral for assistance, e.g., Social worker for financial counseling, assistance – Referral to psychologist/psychiatrist as required.
Study on the Efficacy of Brief Nurse-‐led Interven9ons
• Ethics Approval (NUS IRB). • Funded under a Healthcare Quality Improvement and
Innova9on Project (HQIIF), Ministry of Health, Singapore
• New Pa9ents at the Medical Oncology clinics NCIS • Open-‐label • ‘Control Group’ -‐ those who were not keen for any
interven9on • First visit and monthly for 3 months, then bimonthly for 6
months – (Data presented is for Baseline and 5 months).
Par9cipants
• 121 outpa9ents were offered the interven9on – 79 Women (65%) – 115 Living with Parent/Child/Spouse/Friend/ Rela9ve/Tenant (95%)
– Mixed-‐cancers (38% breast; 10% NPC; 10% lung); mixed-‐stages
– All receiving chemotherapy; 75 completed surgery (62%)
• 70 were keen and 51 received ‘TAU’ – No significant differences in demography between interven9on and TAU (all χ2 comparisons p > .05).
Demography
3
6
35
39
23
11
3
Age
21-‐30 years
31-‐40 years
41-‐50 years
51-‐60 years
61-‐70 years
71-‐80 years
≥81 years
85
13
7 15
Ethnicity
Chinese
Malay
Indian
Others
4
18
48
35
Educa9on
No formal
Primary
Secondary
≥ Ter9ary Numbers represent frequency. Not all subjects answered all items.
Baseline Results
• Baseline differences in anxiety, depression, quality of life (QOL), and distress between interven9on and TAU. – ANXIETY: t(102.68) = 7.25, p < .001 – DEPRESSION: t(114.22) = 5.66, p < .001 – DISTRESS: t(119) = 6.61, p < .001 – QOL: t(106.03) = -‐2.50, p = .014
Comparison of Baseline Distress, Anxiety, Depression, and QOL Scores between Interven9on and TAU Groups
2.51 3.08
1.96
7.82 7.31
4.96
0
1
2
3
4
5
6
7
8
9
Anxiety Depression Distress
HADS
-‐A/-‐D / DT
TAU (N=51) Interven9on (N=70)
63.63
73.24
58
60
62
64
66
68
70
72
74
QOL
EQ-‐5D-‐VA
S
Follow-‐up Results • 63 assessed at baseline and 5 months (Follow-‐up rate:
52%).
• No significant differences in demography between followed-‐up and lost to follow-‐up (all χ2 comparisons p > .05).
• Those lost to follow-‐up had higher anxiety and depression at baseline. – ANXIETY: t(90.42) = 2.71, p = .008; Followed vs. lost (4.37 vs. 6.88)
– DEPRESSION: t(117) = 2.62, p = .010; Followed vs. lost (4.44 vs. 6.68)
Efficacy of Brief Nurse-‐led Interven9ons
• Significant differences in anxiety, depression, QOL, and distress in interven9on across 9me. – ANXIETY: F[1,59] = 52.26, p < .001 – DEPRESSION: F[1,59] = 26.63, p < .001 – DISTRESS: F[1,61] = 12.55, p = .001 – QOL: F[1,55] = 5.61, p = .021
• No significant differences in TAU scores across 9me.
TAU (N=34) Interven9on (N=29)
Comparisons of Anxiety and Depression Scores between Interven9on and TAU Groups across Time
2.51
1.12
7.82
1.74
0
1
2
3
4
5
6
7
8
Baseline 5 months
HADS
-‐A
Anxiety
3.08
1.85
7.31
2.22
0
1
2
3
4
5
6
7
8
Baseline 5 months
HADS
-‐D
Depression
Comparisons of Distress and QOL Scores between Interven9on and TAU Groups across Time
73.24 73.33
63.63
75.00
60
62
64
66
68
70
72
74
76
Baseline 5 months
EQ-‐5D-‐VA
S
QOL
1.96 2.12
4.96
2.52
0
1
2
3
4
5
6
Baseline 5 months
DT
Distress
TAU (N=34) Interven9on (N=29)