Psychosocial intervention

1
Psychosocial intervention

• Cherith Semple
• Macmillan Clinical Nurse Specialist
• Head Neck Oncology
• Ulster Community Hospitals Trust, N. Ireland
• Cherith.Semple_at_ucht.n-i.nhs.uk

2
Overview - Ws

• Why
• Why is there a need for psychosocial
  intervention?
• What
• What is meant by psychosocial intervention?
• What is the aim of psychosocial intervention?
• What approaches have been used in HNC
  psychosocial interventions studies?

3
Ws covered in a recent study

• What?
• What post-treatment problems were targeted?
• What do we know about HNC patients preferred
  mode of intervention delivery?
• What was the duration of the psychosocial
  intervention?
• Who?
• Who was the psychosocial intervention offered to?
  
• HoW?
• How effective was the intervention?

4
Why is there a need for psychosocial intervention?

• Increased awareness that cancer and its treatment
  often leads to psychosocial difficulties
• Improving overall cancer survival rates
• Quality of life and psychosocial well-being are
  important outcome criteria for treatment

5
What is meant by psychosocial intervention?

• Definition is vague
• Overt and subtle difference depending on
  theoretical perspective
• Encompasses a myriad of interventions

6
What is meant by psychosocial intervention?

• Most basic level - psychosocial
• Psycho psychological aspect of our experience.
  Refers to our feelings, thoughts, desires,
  belief, values and how we perceive ourselves and
  others.
• Social refers to the our wider social
  experience i.e. our relationships, traditions and
  culture.
• Both aspects are closely intertwined and
  influence each other.

7
Psychosocial intervention

• Psychosocial intervention is an approach aimed
  at improving peoples well-being.
• Acknowledges
• Psychological well-being of the individual
• Knowledge and skills of the individual
• Social support
• Culture and values that influence individuals
  experience

8
What is the aim of psychosocial intervention for
patients with cancer?

• Decrease physical sequelae (e.g. pain)
• Decrease depression, anxiety
• Enhance adjustment
• Enhance acceptance
• Enhance QOL

9
What approaches have been used in HNC
psychosocial intervention studies?

• Fiegenbaum (1981)
• Hammerlid et al. (1999)
• Clarke (2001)
• Peterson et al. (2003)
• Allison et al. (2004) Vilela et al. (2006)
• Katz et al. (2004)

10
Fiegenbaum (1981)
11
Hammerlid et al. (1999)
12
Hammerlid et al. (1999)
13
Clarke (2001)
14
Peterson et al. (2003)
15
Allison et al. (2004)
16
Vilela et al. (2006)
17
Katz et al. (2004)
18
Overview of psychosocial intervention studies in
HNC

• All but one demonstrated positive findings
• Efficacious in terms of
• Reducing psychological morbidity
• Improving coping skills
• Improving social and functional adjustment

19
Post-treatment challenges for patients with head
and neck cancer

• Numerous
• Span across physical, psychological and social
  domains
• Problems are often inextricably linked

20
Post-treatment problems

• Anxiety
• Depression
• Eating and drinking
• Speech
• Fatigue
• Appearance
• Financial concerns
• Smoking cessation

21
Biopsychosocial framework

• Combination of conceptual models
• - social psychology
• - cognitive and behavioural
• - learning theory
• Metatheoretical approach - no single theory could
  adequately underpin the intervention to treat a
  range of pertinent post-treatment problems

22
Aim of study

• Develop, deliver and evaluate the effectiveness
  of a problem-focused psychosocial intervention
  programme to reduce psychosocial distress and
  improve the quality of life for patients with
  head and neck cancer

23
Treatment approaches

• Psychoeducation
• CBT principles
• - Social skills training (behavioural
  experiments)
• Cognitive restructuring
• Problem-solving

24
What do we know about HNC patients preferred
mode of intervention delivery?
Allison et al.(2004)

• 128 patients
• met inclusion criteria
• 50 patients
• completed intervention
• with outcome data
• 27 (54) 20 (40) 3 (6)
• 1-1 format self-help group

25
Mode of intervention delivery

• Pilot descriptive survey
• Convenience sample
• - 28 patients with HNC
• (completed treatment 6-12mths
  earlier)
• - 19 CBT therapists
• Data collection postal survey
• Data analysis - descriptive

26
Findings

• Preferred mode of intervention delivery

27
Mode of intervention delivery

• Optimal mode - individualised bibliotherapy as
  an adjunct
• Consideration of patients and professionals views
  - responsive to patients needs but translatable
  into practice
• Facilitates clinical judgement, collaborative
  discussion and reinforcement of information

28
Development of intervention programme

• 9 bibliotherapeutic texts produced
• - introductory text (introduction to
  managing cancer related concerns, relaxation
  strategies)
• - one text covering each problematic area
  identified

29
Should all post-treatment patients receive
psychosocial intervention?

• Drop-out rates is higher amongst patients with
  lower levels of psychosocial intervention
• Not economically feasible for patients to engage
  in intervention without an identified need
• Confound findings if patients do not have an
  identified need

30
Inclusion/exclusion criteria

• INCLUSION
• Informed of a head and neck cancer diagnosis
• Completed treatment for head and neck cancer
• Evidence of psychosocial dysfunction as
  determined by the cut-off points on the HAD scale
  ( 8) and, or the WASA scale (12)
• EXCLUSION
• Absence of gross psychopathology
• Previous participation in a structured
  psychosocial post-treatment intervention
• Evidence of recurrent disease

31
Duration of intervention

• Literature review considerable variation
• 1 short intervention
  (McArdle et al., 1996 Burton
  et al., 1995 Holland et al., 1991 Bridge et
  al., 1988)
• 5 - 8 weekly sessions
  (Decker et al., 1992 Edgar
  et al., 1992 Greer et al., 1992 Cain et al.,
  1986)
• ongoing support until death
  (Linn et al.,
  1982)

32
Duration of intervention

• Each patient assessed individually problem
  formulation
• Offered between 2- 6 session
• Maximum 90 minutes per session
• Maximum time span of 2 weeks between sessions
• Received bibliotherapeutic relevant to problems
  identified
• Maximum of 3 problems treated in 1-1 sessions

33
Research design

• Quasi-experimental
• Ethical approval

Completed treatment with psychosocial dysfunction
Self selected
Experimental
Control
Pre-test
Pre-test
Intervention
No Intervention
Post-test
Post-test
34
Data collection

• Experimental group
• Pre-test 6 months from diagnosis, prior to
  intervention
• Baseline data outcome measures i.e.
  HADS, WASA and UWQOLv4
• Post-test 1-week post intervention
• Outcome measures (HADS, WASA, UWQOLv4)
  and patient satisfaction survey )
• - 3-months follow-up
• Outcome measures (HADS, WASA and
  UWQOLv4)
• Control group
• Same standardised measure 6 months from
  diagnosis, 2 and 5 months later

35
Overview of participants who completed study
Participants screened for Psychosocial
dysfunction n129
Above pre-determined cut-off scores On the HAD
WASA scale n68
Eligible for study n61
Refused Participation n7
Experimental group n25
Control group n29
3 month follow-up n24
3 month follow-up n25
36
Data analysis

• Homogeneity at baseline for
• Sociodemographic characteristics
• Disease characteristics
• 4 psychosocial variables
• Social support (SSQ6)
• Optimism (LOT)
• Disfigurement (Observer-rated disfigurement
  scale)
• Coping strategies (COPE-SF)

37
Data analysis to evaluate the effectiveness of
the intervention

• Baseline outcome measures
• Experimental group higher levels of anxiety and
  depression than control group
• ANCOVA
• Between-subject effects - changes on mean outcome
  measure scores between groups regardless of
  baseline scores
• Within-subject effects change sustained over
  time

38
Between-subject differences

• Outcome measure F score p value
• HADS anxiety 12.23 0.001
• HADS- depression 9.05 0.005
• WASA 4.11 0.048
• UWQOL composite 4.38 0.042
• UWQOL transitional 4.31 0.044
• UWQOL overall NS

39
Within-subject effects - anxiety

• Mean anxiety score over time for the experimental
  and control groups

40
Within-subjects effect - depression
Mean depression scores over time for the
experimental and control groups
41
Within-subjects effect social impairment
Mean WASA score over time for the experimental
and control group
42
Findings from descriptive survey

• Generally very satisfied with the psychosocial
  intervention programme
• Supported the statistical data provided on the
  efficacy of the intervention programme
• Four themes identified
• Cognitive restructuring
• Simplicity and usefulness of the booklets
• Combined treatment approach
• Therapeutic relationship

43
Limitations

• Lack of randomisation
• Small sample size
• Research Assistant who collected the
  post-treatment data was not blinded to which
  trail arm participants were in

44
Conclusion

• A problem-focused psychosocial intervention
  programme tailored to individuals needs
  following treatment for head and neck cancer has
  demonstrated efficacy in reducing psychological
  distress, improving social functioning and
  quality of life, which are sustained over time

45
Conclusion

• Post-treatment problems can be managed within a
  biopsychosocial framework
• Patients preferred mode of post-treatment
  psychosocial intervention delivery -
  individualised therapy with bibliotherapy as an
  adjunct

46
(No Transcript)