Interventions which have established roles in managing significant distress in people affected by cancer are summarised below.58
Cognitive behavioural therapy
- Includes cognitive, cognitive behavioural and behavioural therapies. Teaches skills in problem-solving, reframing attitudes, e.g. challenging “black and white” thinking, coping with stress and anxiety. Relaxation therapy, guided imagery or cognitive skills might be used in dealing with stressful situations such as particular treatments, or to reduce nausea associated with chemotherapy. Techniques to enable gradual adaptation might also be included.
- Improvement in emotional distress, coping, anxiety, depression and a psychiatric morbidity; Decrease in nausea, vomiting and insomnia; increase in control over illness.
- Encourages the expression of emotions, validates the experiences of the individual, and offers support through empathetic listening and encouragement, and provision of information. Reflects on the strengths of the individual and encourages use of adaptive coping techniques. Sometimes called supportive, existential or supportive-expressive.
- Improvement in mood, coping and physical and functional adjustment.
- Places emphasis on sharing of experiences among patients with a comparable stage of disease. Participants feel that their experiences are validated, and they can contribute in a meaningful way to the well-being of other members of the group. Can use cognitive behavioural or supportive psychotherapy, and include educational and information components.
- Improvement in mood, coping and adjustment, anxiety and depression; positive immune function changes.
- Enhances communication, cohesion and conflict resolution within the family system, including the needs of children. Can use cognitive behavioural or supportive psychotherapy.
- Targets problems and issues within the couple relationship. Can use cognitive behavioural or supportive psychotherapy.
- Reduces levels of depression and psychological distress. Beneficial in increasing sexual satisfaction.
- Provides geographically-isolated patients with an opportunity for cognitive behavioural or supportive psychotherapy interventions. Also useful for providing casework support, e.g. reassurance, information provision and referral.
- Other therapies may include art therapies, e.g. music, painting, reading and poetry, wellness programs, medication, hypnosis, acupuncture, relaxation, exercise, prayer, laughter etc.
- Improvement in mood, coping, anxiety, depression, breathing; Reduction in nausea and pain.
Other specialist services
- Includes speech therapy, physiotherapy, occupational therapy, dentistry, endocrine therapy, plastic surgery, reconstructive surgery, nutritionist, fertility services, specialised pain services.
- Target specific physical symptoms or impairment resulting from the disease or treatment. Assists in reducing pain, restoring or improving physical functioning or appearance.
The Tiered Intervention Model for Psychosocial Interventions provides a framework which can guide the implementation of psychosocial care (Hutchison, Steginga and Dunn, 2006).5 This framework, adapted in Table 3, is based on the concept of triage or treatment matching following screening to match the level of distress and expressed need to an appropriate level and provider of care. This generic approach can be adapted to any cancer setting through a scoping of existing services to meet the needs at the various levels of the model.59
Table 3: Tiered Intervention Model for Psychosocial Interventions
Adapted from Hutchison, Steginga & Dunn (2006, p.534)59 and Department of Health, Western Australia (2008, p. 21)60
|Level of Distress / Complexity of Need||Level of Intervention||Methods||Appropriate services||Possible target areas / Example of psychosocial issue|
|For all people affected by cancer and minimal to mild distress||Universal care
Information and advice
Information about treatment and specific or common problems
|Primary care team
Tele-based cancer help-lines
Print, electronic and audio-visual patient education resources
|Information about medical treatments
Coping with treatment side-effects
How to talk to / assist a family member with cancer
|Mild to moderate distress||Supportive care
Psycho-education, emotional support and / or triage
|Psycho-education combined with emotional support for mild distress
|Tele-based cancer help-lines
Hospital or community-based support programs, e.g. psycho-education programs, peer support programs, cancer social worker, cancer nurse
|Treatment decision making
Communicating with health professionals
Problem solving specific issues
Coping with emotions
|Moderate distress||Extended care
Focused counselling with psycho-education and coping skills training
|Focused individual, couple, family or group counselling including psycho-education and support||Programs / therapy provided by trained health professional e.g. Social worker, psychologist, psychiatrist, nurse with specific training in supportive care interventions||Adjustment to cancer / grief
Partner support skills
|Moderate to severe distress||Specialist care
Narrow focus with skilled therapist
|Psychotherapy, couple and relationship therapy, or family therapy with mental health practitioner||Cognitive behavioural, interpersonal and supportive expressive therapy by mental health professionals with experience in oncology e.g. Psychologist, psychiatrist, sex therapist, grief therapist
Pharmacotherapy by primary care physician or psychiatrist
|Mood and anxiety disorders
Trauma, relationship and sexuality problems
|Severe distress||Acute care
Broad focus, specialist services or multidisciplinary team
|Therapy with specialist mental health professional to deal with multiple problems||Specialist community or hospital based mental health or psycho-oncology team e.g. Psychologist, psychiatrist, family therapist, multidisciplinary mental health services||Multiple, complex or severe problems
Severe couple problems
Family system problems
Based on the screening and assessment undertaken with Jane, consider which supportive care interventions may be appropriate to support her psychological wellbeing.