Lung Cancer Psychosocial Pilot Group 2010
The lung cancer psychosocial group was established to support lung cancer patients and their families to enable them to share experiences, based on the principles of the Roy Castle Lung Cancer Foundation. Lung cancer patients and their carers may experience emotional difficulties, which may include anxiety, uncertainties and in some cases depression (Macmillan, 2009). The Lung cancer psychosocial group aimed to provide a space for cancer patients and their carers to gain support on a wide variety of lung cancer issues in an informal setting. It also aimed to educate patients and carers about a range of professionals who provide information and advice within Walsall cancer services.
Each group session was facilitated by the lead clinical psychologist in oncology and palliative care and the lung clinical nurse specialists. The group was piloted between October - November 2010. The entirety of the group was over 4 sessions with each session lasted 3-35 hours. Quantitative and qualitative data was gathered. Quantitative data was gathered in the form of the Hospital Anxiety and Depression Scale (HADS) and qualitative feedback was also sought. We also asked participants to complete pre and post Holistic needs assessment which has been identified as an important way to identify distress in cancer patients and signpost patients to appropriate services (Palliative and Supportive care strategy, NICE 2006). The Holistic Needs Assessment has been modified from the national version to suit the local services and implemented for patients at key points of their cancer pathway. Pre and post scores for the screening assessment have also been recorded.
The programme was designed to run with four sessions, which covered the following topics.
Session 1
The Patient experience of diagnosis
Why me? Finding meaning
Emotions
Treatment plans and questions (short term fix / uncertainties)
Shame and Guilt
Benefits advice
Session 2
Anxiety
Depression
Negative automatic thoughts
Complementary therapies
Session 3
Pain, symptom control
Breathlessness
Chemotherapy, other treatments
Spirituality
Session 4
Patient and carer concerns, separately
Round up and endings together with patients and carers
A total of five patients and their carers were invited into the group. However, a maximum of three patients and their carers attended.
Depression and Anxiety
The HADS scale was used as an outcome measure, so all patients and carers completed the HADS at the beginning of the group before the first session and then at the end of the fourth session. The contents of each group were also qualitatively evaluated at the end of each session and overall feedback of the group was collected.
Below are graphs that illustrated the changes made by each patient and carer on levels of anxiety and depression before and after the group. The clinical cut off’s scores for the HADS are as follows: 0-7 = Normal, 8-10 = Mild, 11-14 = Moderate and 15-21 = Severe.
Graph 1. Patients Anxiety scores
The graph above illustrates that both patients 1 and 2 had slight increased scores of anxiety after the group. However, patient 3 had a reduction of 3 points in anxiety score. All three patients had scored within the mild range of anxiety. The fact that the post anxiety scores are higher maybe due to the element of both patients 1 and 2 were undergoing palliative treatment i.e., chemotherapy and/or surgery and their anxieties are therefore appropriately reflected in their scores.
Graph 2. Patient Depression scores
In the graph above, Patients 2 and 3 had reductions of depression scores post group intervention. Patient 1 depression score had increased. This again is a reflection of patient 1 undergoing palliative chemotherapy and/or surgery. All of the patients score fell within the normal-mild range of depression.
Graph 3. Carer Anxiety Score
The above graph illustrates mixed results where carer 2 had a 2 point reduction in their anxiety score and carer 3 showed an increase of anxiety. Carer 1 only completed a post group HADS and therefore no difference of scores can be made. All carer scores fall within the ‘normal’ range of anxiety. Once again, as 2 of the patients were undergoing palliative treatments, then this would naturally be reflected in the scores for their carers.
Graph 4. Carer Depression scores
The carer anxiety score graph results as depicted above, are varied and are similar to the anxiety scores graph. Carer 2 showed no change in depression score, carer 3 demonstrated an increase from a score of 0 pre group score, to 3 post group score. Carer 1 only completed the post group data. All carer scores fall within the ‘normal’ range of depression. It is worth bearing in mind once again that scores for patients are often reflected in the scores for carers as 2 of the patients were undergoing palliative treatment.
Holistic Needs Assessment
The results from the holistic needs assessment tool have been collected at session 1 and 5 out of 6 participants completed this. The tool was repeated at the final session and all 6 participants completed the post assessment tool. The UK validation study for the HNA outlined that a score of 4 or below implies care as usual. However, patients scoring 5 or 6 should be drawn to the attention of the clinical team and monitored. Finally, patients scoring 7 and above should be considered for a referral to psychology services and discussed at the multi-disciplinary team meeting.
Table1. Holistic needs distress scores
Patient / Pre Distress / Post Distress1 / 4 / N/A
2 / 0 / N/A
3 / 4 / 4
4 / 4 / 3
5 / 0 / 4
6 / N/A / N/A
Mean score / 2.4 / 3.7
The mean group score of distress pre intervention was 2.4 which indicated the group were within the ‘normal’ range of distress. The post score was also within the range of thereby keeping within the ‘normal’ range.
Table 2. Holistic Assessment Needs number of concerns
Patient / Pre Number / Post Number1 / 6 / 5
2 / 4 / 3
3 / 1 / 2
4 / 6 / 4
5 / 5 / 2
6 / N/A / 3
Mean / 4.4 / 3.2
However, the number of concerns participants had before and after the course reduced following the course suggesting that information and support they gained from attending was received positively. The mean number of concerns pre-course was 4.4 and post-course 3 so this shows a reduction in concerns.
Qualitative Outcome
The table below presents the content of each session alongside the qualitative feedback gained:
Table 3. Qualitative Feedback by session
Session 1Organisation/Venue / · Excellent
Content / · Really did feel the support came through and felt able to verbalise my thoughts and feelings. Very helpful. As the gentleman said “wouldn’t have missed it”
· Very interesting and informative. Also very friendly glad we came.
· Really made to feel welcome so glad we decided to come. People we met great really enjoyed it.
· Found meeting very informative
· Found the speakers very pleasant, making you feel at home
· Excellent day- lots of further knowledge gained. Entertained.
The strengths of this day / · The structure and getting to the ‘nitty gritty’ of coping with cancer
· Been thoroughly entertained
· Meeting new people and exchanging ideas and thoughts, good day.
The day could have been improved by / · A little more sensitivity from social worker but I think he learned
The day is useful to me in the following ways / · Confirming that my thoughts and feelings are normal
· Gained extra information about finances
Any other comments or suggestions / · Please continue! It is very good work
Only one participant attended the second session due to the other 2 patients receiving active palliative treatment, therefore no formal feedback was received.
Session 3Organisation/Venue / · No Comment
Content / · Excellent
The strengths of this day / · Ability to share problems and hurdles! Advice on breathlessness
The day could have been improved by / · No comment
The day is useful to me in the following ways / · I need to reflect on the input from team members with varied skills
Any other comments or suggestions / · No Comments
Session 4
Organisation/Venue / · No comments were made
Content / · Excellent group gives support on all aspects. Wonderful for exchange of ideas.
· Found session very helpful in understanding feelings
· Presented in a way that includes and involves everyone. People are drawn in and voice their worries.
The strengths of this day / · Exchanging of most ideas and talking them through
· To be able to ask questions and be reassured
· Sharing problems
· Able to express myself
· Listening to those with cancer voice their feelings – seeing them feel safe and strong enough to do so.
The day is useful to me in the following ways / · Listening to others with similar problems
· Helps me to see that the feelings my family and I have are quite normal
Any other comments or suggestions / · No comments were made
Qualitatively the participants evaluated the content and delivery of the group sessions well.
Overleaf is a summary of the comments the participants made about the overall impression of the lung group.
Table 4. Overall feedback
Lung Group Pilot FeedbackOverall impression of the group / · Excellent and making new friends – being able to talk about concerns
· Very good, very supportive
· Helpful – attendance helps one feel less isolated
· Good
· The group should be kept going – it seems obvious that those involves get strength and support from other members
What session you got most from / · Session four - more people, more discussion
· Impossible to say. All were helpful for different reasons
· Unfortunately we were unable to attend sessions 2 & 3 but attending the others
· Let us talk and comment and best of all be positive
What session you got least from / · No comments were made
Further improvements that can be made to the group / · No good advice to offer!!!!
· I don’t think the content can be improved but others with cancer and their carer’s don’t know what they’re missing so try and persuade more to attend.
Recommend group to others / · A big YES a very firm YES, is the answer to this question
All six participants said they would recommend this group to others
Summary:
The overall qualitative feedback data suggests that patients and carers enjoyed and valued the group. The participants commented on the benefits of being with others who shared a similar experience to them and valued sharing ideas between each other. The outcome scores on the HADS suggest that patients and carers may experience varied levels of anxiety and depression. However all the patients and carer’s have remained within the normal to mild range for anxiety and depression and were able to support one another appropriately.
Although the pilot group numbers are very low, the clinical nurse specialists in lung and the lead clinical psychologist in oncology and palliative care have agreed to continue providing this format of support to all newly diagnosed patients whether they are palliative or not. Ongoing groups have been time tabled for the year to follow in the same format and all patients who are now diagnosed with lung cancer will be offered this group as a means of treatment to address the emotional and physical aspects of the illness. Outcome measures will also continue to be collected.
Author:
Dr Shradha Lakhani
Clinical Psychologist in Oncology and Palliative care
Walsall Community Health Trust
Tel: 01922-858450
Email:
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