Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients—A randomised study of nurse versus psychologist interventions

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Abstract

Objective

In a prospective, randomised study, individual psychosocial support performed by: (1) specially trained oncology nurses (INS) or (2) psychologists (IPS) were compared with respect to utilisation, satisfaction and perceived benefit.

Methods

Between December 1997 and December 1999, consecutive breast cancer patients (n = 120) were included at start of adjuvant therapy (chemo-, endocrine and/or loco-regional radiotherapy). Data were collected by an extended version of the ‘IPS-patient satisfaction questionnaire’ within 1 week after termination of the support intervention. Questionnaires were also mailed to all patients 6, 12 and 18–24 months after inclusion. Levels of distress were collected with the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale (IES) questionnaires.

Results

The patients were highly satisfied with the individual psychosocial support intervention they received, irrespective of which profession provided the support. However, the patients in the INS group reported higher levels of benefit regarding disease-related problems, regardless if the patients at baseline reported low or high levels of distress.

Conclusions

Patients were highly satisfied with an individual psychosocial support intervention. In areas dealing with somatic aspects, the group intervened by nurses were more satisfied than the one by psychologists.

Practice implications

Individual psychosocial support by specially trained nurses is a realistic alternative in routine cancer care.

Introduction

Psychosocial support interventions for cancer patients are often evaluated in terms of anxiety, depressive symptoms, coping and quality of life, as assessed by standardised questionnaires. In addition, however, it is vital that patient satisfaction is evaluated due to the complexity of the psychosocial support [1]. Patient satisfaction is associated with continuity of care [2], [3], [4], which in turn, is related to treatment compliance and better clinical outcome [5]. Patient satisfaction is also of importance to enhance psychological adjustment and coping with the disease [6], [7], [8], [9]. Walker et al. [10] suggest that patient satisfaction may be enhanced when hospital staff provides for the psychosocial needs associated with the cancer diagnosis.

Patient satisfaction with an individual psychosocial support intervention performed by psychologists was measured in a previous intervention study [11]. The patients stated that their problems were addressed to great extents. Further, those who reported having problems perceived more benefits with the support compared to patients reporting no problems. An overwhelming majority of the patients would recommend the support to a close friend.

Few psychologists are employed for the treatment of psychosocial problems among cancer patients in Sweden today, as in most other countries. This is an important reason for exploring the effects of psychosocial support performed by other professionals. Maguire [12] has suggested that nurses should be educated in techniques to relieve psychosocial problems. According to Lovejoy and Matteis [13], nurses trained in cognitive-behavioural skills should take an active role in preventing and managing cancer-related depression.

In a randomised intervention study, the “Support Project”, the aim was to compare the effects of individual psychosocial support to breast cancer patients provided by: (1) oncology nurses specially trained in psychological techniques (individual nurse support, INS) or (2) psychologists (IPS) to (3) standard care (SC). The influences on quality of life, anxiety and depression have been reported separately (Arving et al., submitted for publication). Overall, the patients in all three groups improved both clinically and statistically significantly on a number of variables over the 6 first months after surgery. In addition, the study revealed positive effects of both INS and IPS as compared to SC on global quality of life, side effects and post-traumatic distress. The results indicate that psychosocial support is beneficial for some breast cancer patients and that psychosocial support by nurses is as effective as that given by psychologists. However, although none of the interventions were shown to be more effective than the other, it is important in the evaluation of the two interventions to study whether there were differences in the patients’ satisfaction, perceived benefit and utilisation between those in the INS and those in the IPS. The present report describes the patients’ utilisation of, benefits from and satisfaction with the intervention provided by the two professionals. The following specific research questions were addressed:

  • Were there differences between the randomisation groups in patients’ utilisation of, satisfaction with and perceived benefit of the interventions directly after termination of the interventions and 6, 12 and 18–24 months after the start of the intervention?

  • Were there differences between the randomisation groups’ according to whether they reported having problems or not, or if they reported scores indicating being cases of depression, anxiety or distress on the HADS and IES questionnaires, respectively, at the same time points?

Section snippets

Patients

A total of 425 consecutive breast cancer patients, living in Uppsala County, Sweden and about to start adjuvant treatment at the Department of Oncology, Uppsala University Hospital between December 2nd 1997 and December 31st 1999 were eligible. Patients with a previous cancer diagnosis, those who had an ongoing psychiatric illness, and those who did not speak or understand Swedish were excluded (n = 111, 26%). Twenty-six patients (6%) were missed at inclusion because they were referred directly

Participation

Of the original 120 patients randomised to the two intervention groups, 3 (5%) in the INS-group and 5 (8%) in the IPS-group failed to attend the first session. Out of these, 1 in the INS-group and 2 in the IPS-group had discontinued participation in the research project before the first contact, since they could not be reached by telephone or by mail in time. Of the 112 patients who attended at least one session, 30 (27%), 12 in the INS group and 18 in the IPS group, did not answer the

Discussion

Breast cancer patients were highly satisfied with the number of sessions and the timing of individual psychosocial support, irrespective of which profession provided the support. In addition, many patients reported that their problems, if present, were addressed to a large extent during the sessions and that these had fully or partly helped them in dealing with their situation. Nearly, all patients stated that they would recommend the INS or IPS to a close friend in a similar situation. These

Acknowledgement

The study was supported by grants from the Swedish Cancer Society.

References (24)

  • M.L. Slevin et al.

    Emotional support for cancer patients: what do patients really want?

    Br J Cancer

    (1996)
  • X. Wang et al.

    Major concerns and needs of breast cancer patients

    Cancer Nurs

    (1999)
  • Cited by (0)

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