Satisfaction, utilisation and perceived benefit of individual psychosocial support for breast cancer patients—A randomised study of nurse versus psychologist interventions
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)
- et al.
Individual psychological support for cancer patients: utilisation and patient satisfaction
Patient Educ Couns
(1998) - et al.
Assessment and treatment of psychosocial problems in cancer patients: an exploratory study of a course for nurses
Patient Educ Couns
(2001) - et al.
Mind and cancer: does psychosocial intervention improve survival and psychological well-being?
Eur J Cancer
(2002) - et al.
Psychological functioning in cancer patients treated with radiotherapy
Patient Educ Couns
(2004) - et al.
Emotional support and the role of Clinical Nurse Specialists in palliative care
J Adv Nurs
(2003) - et al.
Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire
J Clin Oncol
(1999) - et al.
Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial
Br J Gen Pract
(1999) - et al.
Patient and GP agreement on aspects of general practice care
Fam Pract
(2002) - et al.
Patient compliance is critical for equivalent clinical outcomes for breast cancer treated by breast-conservation therapy
Ann Surg
(2000) - et al.
A comprehensive assessment of satisfaction with care: preliminary psychometric analysis in French, Polish, Swedish and Italian oncology patients
Patient Educ Couns
(2001)