Bea$ng'the'blues'against'cancer:' a'community'approach'to'psychological' care' ! ! Jeff'Dunn' ! ! Griffith!Health!Ins/tute,!Griffith!University! Centre!for!Research!in!Cancer!Control,!Cancer!Council!Queensland! ' ' ! ! !
Background' • Substan/al!subgroup!of!pa/ents!and!carers! experience!heightened!psychological! distress! • Need!to!/trate!care!to!level!of!distress! However….! • Psychological!care!needs!to!be!accessible! and!cost!effec/ve!
The'Tiered'Model' Acute'Care: !!Intensive!or!comprehensive! therapy!for!acute!and!complex!problems! eg.!mental!health!team,!psychiatrist. Severe' Specialist'Care:' Specialised ' therapy!for! depression,!anxiety,!rela/onship! distress' problems!eg.!psychologist,!psychiatrist. Moderate'' Extended'Care:' Counselling,!/me!limited! to'severe'' therapy,!skills!training!eg.!psychologist,! distress' social!work,!QCF!teleKbased!Cancer! Counselling!Service.! Moderate'distress' Suppor$ve'Care:' Emo/onal,!prac/cal,! spiritual,!psychoeduca/on,!decision! support,!peer!support!eg. ' social!worker,! peers,!chaplain ������������������� Mild'to'moderate'distress' Universal'Care:' Informa/on,!brief! emo/onal!and!prac/cal!support! eg.!health!care!team,!QCF!Cancer! Minimal'to'mild'distress' Helpline. Hutchison, Steginga, Dunn (2005)
The'Bea$ng'the'Blues'ADer' Cancer'Project' • Randomised!control!trial!of!psychological! interven/on!for!high!distress!Cancer! Helpline!pa/ent!and!carer!callers!(>4!on!DT)! • Compares!two!low!intensity!interven/ons:! single!nurse!session!and!self!management! vs.!five!psychologist!sessions!(CBT)! • TeleKbased! • Twelve!months!follow!up!
Inclusion'Criteria' • Cancer!pa/ent!or!carer!over!18years!who! called!the!Cancer!Helpline! • Have!a!score!of!4!or!more!on!the!Brief! Distress!Thermometer!when!Helpline! contacted! • Be!able!to!read!and!speak!English! • No!previous!history!of!head!injury,! demen/a!or!psychiatric!illness!
Background'details'for'Pa$ents'and'Carers' Pa$ents' Carers' Demographic'Variable' N=354' N=336' Mean'( SD )' Mean'( SD )' Age'' 58.25'(11.23)' 52.52'(12.71)' %' %' Gender' Female' 82.5' 87.8' Male' 17.5' 12.2' Marital'Status'' Married/defacto' 39.5' 20.9' Not'married'(single,'widowed,'divorced)' 60.5' 79.1' Educa$on'' School'(<'grade'12)' 42.6' 34.0' Ter$ary' 57.4' 66.0' Income' <$20,000'' 18.6' 11.5' $20,000'a'less'than'$40,000'' 27.7' 27.1' $40,000'a'less'than'$60,000'' 14.1' 13.1' $60,000'a'less'than'$80,000'' 9.9' 9.7' $80,000'+'' 23.4' 33.0'
Sample'Characteris$cs' Time!since!diagnosis!(M=1.74years;!SD=2.19)! Half!the!sample!(49.4%;!53.4%!pa/ents!&!45.2%! carers)!reached!caseness!for!distress!in!one!or!more! of!the!BSI!subscales:! K Pa/ents:!33.5%!caseness!in!soma/sa/on,!31.5%!in! depression,!and!32.0%!in!anxiety.!! K Carers:!17.7%!displayed!caseness!in!soma/sa/on,! 31.1%!in!depression,!and!35.9%!in!anxiety! ! !
Results' Support!Service!Use! Prior!to!entering!the!trial,!only!21.5%!of!par/cipants!had!sought!psychosocial! services!in!the!past!month! ! Support'Service'Use' N'(%)' ! Have!you!seen!a!psychiatrist,!psychologist,!counsellor!or!social! 149!(21.5%)! worker!in!the!past!month?! Psychiatrist! 15!(10.1%)! Psychologist! 53!(35.6%)! Counsellor! 24!(16.1%)! Social!Worker! 76!(51.0%)!
Results' Sources!of!Emo/onal!Support! Most!frequent!sources!of!emo/onal!support!were!family!and!friends,! followed!by!the!doctor,!and!nurse! Sources'of'Emo$onal'Support' N'(%)' Have!you!accessed!any!of!the!following!services!for!emo/onal!support!in!the!past! month?! Doctor! 155!(22.4%)! Nurse/other!health!professional! 98!(14.2%)! Family/friends! 567!(81.9%)! Online!cancer!support!group! 31!(4.5%)! Face!to!face!cancer!support!group! 28!(4.0%)! Other!support!groups! 32!(4.6%)! Community!counselling!services!(e.g.,!Lifeline,!Centacare)! 20!(2.9%)! Government!organisa/ons!(e.g.,!Veteran’s!Affairs)! 10!(1.4%)! Community!organisa/ons!(e.g.,!Red!Cross,!Salva/on!Army)! 12!(1.7%)! Other! 149!(21.5%)!
Results' Study!Reten/on!PostKInterven/on!(3!months)! ! Reten/on!rates!were!high!(84.4%)! K Greater!for!par/cipants!comple/ng!the!brief!nurse!session! (89%)!compared!to!the!five!session!psychologist! interven/on!(79.8%;!p!=!.0009)!! K Poorer!for!carers!(79.6%)!compared!to!pa/ents!(89%;!p!=!. 0007)!
Conclusions' • Both!interven/on!approaches!highly! acceptable:!brief!session!bemer!reten/on! • Most!callers!had!not!sought!out!specialist! mental!health!services;!and!relied!for! support!on!family!and!friends! • Analysisis!will!focus!what!is!effec/ve,!for! whom!and!at!what!cost/benefit.!
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