The psychological well-being of people affected by cancer is proactively considered and addressed continuously throughout their care.
All workers participate in education and training programmes to increase their awareness and understanding of the psychological impact on the person affected by cancer and their whānau.
Staff providing advanced psychological interventions are qualified to do so and provided with further training to enhance these skills for the cancer context.
People are affected by cancer in an emotional as well as physical way. Studies have shown that within the treatment population the level of distress which requires intervention is between 30-60%. It is recognised that those supporting the person with cancer may also be emotionally affected and may have significant psychological needs.
Research has identified various points of screening or assessment linked with the patient moving through treatment stages, or at specific points in the cancer pathway. What is recognised from the workforce involved in this work is that assessment for psychological need has a place throughout the cancer continuum in a systematic fashion, but should also be responded to when there is evidence of need.
Psychological issues which arise can have an impact on the person’s engagement with their treatment, the side effects they experience and their recovery. Issues can vary widely from those requiring specialist interventions via psychology or psychiatry to a time limited adjustment reaction which requires a less specialist intervention. It is important for people affected by cancer and the workforce involved in their care that there are processes in place to access this specialist help when needed, but also that all staff have the skills to screen for the emotional impact of having cancer.
It is accepted practice internationally that cancer treatment centres have a screening system in place for distress. Studies have shown that staff cannot always accurately gauge how much distress a person is experiencing or what is causing that distress. Screening is a process which is undertaken on every person with cancer and is a way of identifying potential issues. Assessment is a more in-depth conversation with the person affected by cancer to understand their ongoing needs. This means that the role of all staff is to screen for the need for intervention and for some staff their roles are to assess.
“Seek help with accepting your diagnosis
and then seek help if you’re feeling down…”
Cancer Stories Aotearoa – Kahui Korero Taumahatanga o Te Mate Pukupuku
Good Practice Points
· Services utilise a well-developed algorithm defining the referral pathway a person is guided down if and when psychological care concerns are identified. A referral model based on a tiered level of specialist service need is developed for each treatment service.
· Links between services are clear and agreed so that those affected by cancer have access to psychological services appropriate to their needs.
· Service design incorporates the principles of Whānau Ora, ensuring that an inter-sectoral approach for service provision is utilised.
· Services employ health practitioners with the requisite skills and qualifications to meet the psychological needs of people affected by cancer.
· All staff are provided with debrief opportunities after a particularly difficult or distressing intervention.
· Within primary health the use of the Kessler 10 is recommended and should be understood by secondary/tertiary services to allow the transfer of information regarding anxiety and depression which may be present prior to diagnoses.
These tools can be found at:
Organisations implementing distress screening need to consider the following:
· Whole service education and service development to occur if screening tools are to be implemented, to ensure a readiness to respond to referral.
· Communication skills need to be part of a distress screening package as a conversation is the best method to capture the information around someone’s mood, coping and distress levels.
· Monitoring of the use of, and barriers to, screening tools needs to be identified.
· Only tools which have been adapted to and validated in the New Zealand context should be used to contribute to Māori health gains. To date, the Distress Thermometer is an accepted screening tool and one for which there has been New Zealand adaptation and validation.
Good Practice Points System
· Investment in psychological care services for people affected by cancer is prioritised.
· Research is undertaken to identify effective psychological services, interventions and measures that support those affected with cancer.
· The development of NZ-based tools for screening and assessment is promoted to ensure the tool itself does not create an inequity.
· Undertakes training and education on the psychological needs of people affected by cancer.
· Understands different ages and developmental needs, as well as stages and their impact on responses.
· Incorporates the importance of understanding different cultural contexts, including expressions of distress in populations culturally and linguistically diverse from their own.
· Recognises individuality and difference in people’s reaction to stressful events.
· Is proactive in looking for signs of difficulties and gives space for distress to become evident.
· Is equipped to respond to immediate distress and provide supportive interventions until/if further specialist intervention is required.
· Understands the role, function and access criteria for all members of the interdisciplinary team, and is able to identify reasons for escalation to more specialised support.
· Undertakes ongoing training, which increases their understanding of how different cultures grieve and the customs around illness and death.
· Is aware of how the social determinants of access to health services may cause barriers to effective psychological care and considers how to overcome them, including past life challenges.
Training and Resources Available
· Psychosocial Oncology New Zealand www.ponz.org.nz.