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Psychosocial Interventions in Cancer Nursing:Implementing … · 2018-04-02 · interventions •...
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Psychosocial Interventions in
Cancer Nursing:Implementing
Evidence into Practice
M. Eicher
ICCN Plenary Session IV
12 July 2017
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President elect Lena Sharp, Sweden
President Daniel Kelly, UK
Past President Erik van Muilekom (The Netherlands)
Greetings from EONS
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Greetings from Switzerland
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Overview
1. Psychosocial interventions: Role of cancer nurses
2. Challenges for cancer nurses when providing
psychosocial care
3. Future developments in psychosocial care and potential
roles cancer nurses could play
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Psychosocial Care: Importance
Identification of distress as the 6th Vital Sign of cancer care
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Unmet needs as expressed by patients
• ‘It does feel like after your last chemo session you are on
your own. It’s then when you are not so much supported
by nurses/doctors etc, that it hits home what has
happened and the ‘mental health’ element kicks in. That
is where I feel support is lacking.’
• ‘In hindsight I probably did need support but wasn’t
aware of it at the time – emotional needs weren’t
discussed with the nurses doing consultations, I think
they were too busy.
Psychological and emotional support provided by Macmillan Professionals: An evidence review. 2011 www.Macmillan.org.uk/servicesimpact
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Host “omes” • Genome • Epigenome • Transcriptome • Metabolome • Microbiome
Profiling
• Environment • Lifestyle • Co-morbidities • Health history • Health Literacy • Psycho/emotional/cogniti
ve needs
HOLISTIC VIEW
Personalized Cancer Treatment
(Bio)markers
MULTILEVELED STRATIFICATION
DIAGNOSTIC AND TREATMENT
MOLECULAR TARGET
Personalized Cancer Care
PREDICTIVE/ PREVENTIVE/SUPPORTIVE CARE
RISK / NEEDS
Psychosocial support in the era of precision medicine
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Challenges in the era of precision medicine
A comprehensive precision medicine approach should
encompass:
• Predictive
• Personalized
• Preventive
• Participatory
• Psycho-cognitive aspects
Gorini A, Pravenotti G. 2011 P5 medicine: a plus for a personalized approach to oncology. Nat Rev Clin Oncol May 31; 8(7):444; doi: 10.1038/nrclinonc.2010.227-c1.
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Psychosocial support: International guidelines
• Psychosocial oncology has
grown over the last decade.
• It is not possible to organize
cancer care without a specific
investment in psychosocial
oncology.
• Psychosocial oncology (…) is not
an integral part of cancer care
in many countries, especially
developing nations, where basic
care is sometimes not provided to
cancer patients.
Grassi L. et al. Psycho-Oncology 21: 1027–1033 (2012) DOI: 10.1002/pon
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Psychosocial support: Definition
• psychological, social and spiritual
care services and interventions
• enable patients, their families, and
health care providers to optimize
biomedical health care and to
manage the psychological /
behavioural, social and spiritual
aspects of illness and its
consequences so as to promote
better health
Canadian Association of Psychosocial Oncology (2010) Standards of Psychosocial Health Services for Persons with Cancer and their Families, www.capo.ca
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Psychosocial Support: Definition
Canadian Association of Psychosocial Oncology (2010) Standards of Psychosocial Health Services for Persons with Cancer and their Families, www.capo.ca
Psychosocial Oncology
• focuses on the emotional distress aspects of cancer care and is
particularly concerned with the assessment and treatment of
distress and the management of complex issues.
• offers care to persons with cancer who have specific unmet needs
related to coping with their illness, emotional distress, changes in
relationships and planning for the next phase of their lives.
• is addressed by professionals trained in this sub-specialty (e.g.,
psychologists, social workers, spiritual care specialists, psychiatrists
and psychiatric/mental health advanced practice nurses [APNs]).
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Psychosocial Support: Definition
Canadian Association of Psychosocial Oncology (2010) Standards of Psychosocial Health Services for Persons with Cancer and their Families, www.capo.ca
Supportive Care services
• Address a range of needs, including informational and counselling
needs related to the management of symptoms and specific practical
or functional issues.
• A variety of disciplines may be involved in provision of supportive care,
such as nursing, medicine, nutrition and rehabilitation services.
• Address unmet needs of persons with cancer who require information,
education, support, financial advice, or other practical advice.
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Psychosocial interventions: Definition of the
NCCN / IOM report
• non-pharmacological
• interpersonal relationship between a patient or group of
patients and one or more trained (usually professional)
helpers
• key types of psychosocial care:
• Cognitive Behavioral Therapy
• Supportive Psychotherapy
• Family Therapy
Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donelly, M: Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews 2012, p. 4; NCCN guideline: Distress Version 1.2015; Adler N, Page A, Institute of Medicine: Cancer Care for the whole patient: Meeting psychosocial health needs National Academic Press. 2008;
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Who is providing psychosocial care?
40% 37%
16%
Nurses Psychologists Social workers
Proportion of providers of the interventions (%)
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Effectiveness of psychosocial care:
Comparing providers of the intervention
Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donelly, M: Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews 2012, p. 4
GP
Combination: Social Worker, Psychologist, GP
Psychologist
Nurse
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Effectiveness of psychosocial care:
Comparing providers of the intervention
• 27 studies (n=3324)
• 7 studies reported significant
effects
• 5 of the effective
interventions were provided
by (oncology) nurses:
– education about fatigue
– teaching in self-care or coping
techniques
– facilitation of activity management
learning
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Uptake and adherence to psychosocial care:
Who takes up?
• 53 studies (n= 12 323 cancer
patients) reporting 60.1% uptake
/ 90.4% adherence for
psychological interventions
• Patients screened and identified
as distressed were less likely to
accept intervention than
unselected patients (50.3% vs.
66.3%)
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Uptake and adherence to psychosocial care:
Acceptance
• Uptake was higher for
interventions delivered by
telefone than face to face
(71.2% vs. 53.8%) and when
interventions were offered prior to
medical treatment compared
with later (72.9% vs 56.8%)
• Patients were more likely to
accept intervention from nurses
than other health professionals
(68.3% vs. 50.5%)
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Are nurses recognised as important providers of
psychosocial care?
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Overview
1. Psychosocial interventions: Role of nurses
2. Challenges for nurses when providing psychosocial
care
3. Future developments in psychosocial care and
potential roles nurses could play
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Psychosocial interventions revisited
• non-pharmacological
• interpersonal relationship between a patient or group of
patients and one or more trained (usually professional)
helpers
• three key types of psychosocial care:
• Cognitive Behavioral Therapy
• Supportive Psychotherapy
• Family Therapy
Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donelly, M: Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews 2012, p. 4; NCCN guideline: Distress Version 1.2015; Adler N, Page A, Institute of Medicine: Cancer Care for the whole patient: Meeting psychosocial health needs National Academic Press. 2008;
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Diffusion of Distress Management Guideline
into practice
• Observational study conducted in 2013 in the US
• Study respondents (n = 409) were predominantly certified nurses (84%)
• 17% of respondents were using the Distress Management Guideline (DMG)
• Time, staff uncertainties and ambiguous accountability were the
largest barriers to not assessing distress
• Significant predictors of DMG use included:
• higher familiarity with the DMG (OR 3.81, p < .001)
• lower perceived barriers (OR 0.41, p = .001)
Tarvernier S, Beck L. Dudley N. Diffusion of a Distress Management Guideline into practice. Psycho-Oncology 22: 2332–2338 (2013) DOI: 10.1002/pon.3295
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Psychosocial interventions might request a behavior
change of intervention providers first
Michie et al. Implementation Science 2011, 6:42; http://www.implementationscience.com/content/6/1/42
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Overview
1. Psychosocial interventions: Role of cancer nurses
2. Challenges for cancer nurses when providing
psychosocial care
3. Future developments in psychosocial care and
potential roles cancer nurses could play
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Cancer a global concern
Stewart BW, Wild CP, editors (2014). World Cancer Report 2014. Lyon, France: International Agency for Research on Cancer.
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Psychosocial support: Targeted and tailored
Canadian Association of Psychosocial Oncology (2010) Standards of Psychosocial Health Services for Persons with Cancer and their Families, www.capo.ca Adapted from Fitch, M. I. (2008): Supportive Care Framework: Theoretical Underpinnings, in M.I. Fitsch, H.B. Porter & D.B.Page (eds.): Supportive Care Framework: A Foundation for Person-Centered Care..
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Key design features for psychosocial support
interventions
Schofield, P. & Chambers, S. (2015), Acta Oncologica, Early Online
1. Target; e.g. cancer type, treatment stage
2. Tailor; individual needs
3. Self-management support
4. Low intensity; integrated professional support with other
mechanisms; e.g. technology
5. Training; adherence to intervention
6. Evidence-based
7. Stakeholder involvement
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Self-Management Support: What is effective?
The Health Foundation (2011): Helping People help themselves. http://www.health.org.uk/sites/health/files/HelpingPeopleHelpThemselves.pdf
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Swiss study: Co-creation and testing of a peer-led self-management
program for Breast Cancer Patients
Diagnosis Therapy Follow-up
Eicher M, Haslbeck J, Urech C, Ribi K, Holm K: Co-creating and testing the effectiveness of an integrated peer-to-peer Selfmanagement program for breast cancer Survivors: A pilot study (COSS)
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Swiss example of an effective psychosocial low intensity
intervention
• web-based stress management
intervention
• 8 modules with weekly written
feedback by a psychologist
(“minimal-contact”) based on well-
established stress management
manuals
• program was feasible and
effective in improving QoL and
distress
Hess V, Grossert A et al J Clin Oncol 35, 2017 (suppl; abstr LBA10002)
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Can we delegate psychosocial interventions to
digital devices?
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Why does an intervention work?
Effectiveness of an intervention can
be predicted by:
• team knowledge and skills
• contextual factors at the
– system (external policy and
incentives),
– facility (management support)
– and team (knowledge and
skills) levels.
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Implementation Research
Damschröder et al. The consolidated framework for Implementation Research. Implementation Science 2009, 4:50 doi:10.1186/1748-5908-4-50
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Model of quality cancer care including
psychosocial aspects
Fann J, Ell K, Sharpe M, Integrating Psychosocial Care into Cancer Services. Journal of Clinical Oncology 30/11. 2012, p. 1181
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Take Home Message
• Cancer Nurses play a most pivotal role in the provision of psycho-social
interventions
• To be able to provide evidence based interventions, cancer nurses need to
be equipped with adequate:
• education and training
• infrastructure and time
• guidelines that adress the specific roles and functions of nurses adequately
• Future investigations in psycho-social interventions need to enhance:
• tranparency about the intervention provision in studies
• rigorously planned implementation studies that take the complexity of the
context of an intervention provision into account (e.g. by referring to established
frameworks such as CFIR / PARIHS / RE-AIM )
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Merci beaucoup!
Institut universitaire de formation et de
recherche en soins – IUFRS