Background: Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive.
Method: This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components.
Discussion: This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach.
Trial registration: Open Science Framework, 46033. Registered 19 April 2018.
Many patients, family and staff use the word ‘traumatic’ when discussing end-of-life experiences. As with many terms we have considered in this series, ‘trauma’ and ‘traumatised’ mean something more specific in a clinical sense than they do in common usage. What does it mean to be traumatised, and how might we recognise and manage this condition in a palliative care setting?
Personality can be thought of as a set of attitudes and behaviours that are relatively consistent across time and circumstances. The author details different types of personality disorder and explains their needs at end of life.
In the seventh article in our series ‘Psychology in palliative practice’, Jenny Strachan looks at how distress, a common phenomenon at the end of life, affects the psychological well-being of patients receiving palliative care and that of their families. When is it a normal reaction and when is it so intense that it’s problematic or clinically significant? She advises on the process of adjustment, which allows people to find a new equilibrium that takes account of the disturbing changes in their lives, and on the different models devised to explain its operation. Jenny also outlines how coping strategies fit into the picture and gives guidance on identifying barriers to coping and working effectively with patients and families in distress to encourage them to find an equilibrium.
Jenny Strachan examines how encouraging patients to change certain types of behaviour – such as non-compliance with medicines, persistent reassurance seeking and strain in family relationships – ultimately boils down to understanding and adjusting the relationship between the behaviour and its reinforcers.
One way of thinking about psychological difficulties is to take a diagnostic approach: which category of problem does this patient have? However, when we are working individually with a patient, we find it more helpful to take a formulation approach.
We are all born with the capacity to experience emotions. Much has been written about how and why we experience them, but there is a consensus that they help us to understand and respond to the complex situations and relationships that are part of being human.
There is growing recognition in the palliative care community of the emotional and psychological needs of patients – and their carers – as they reach the end of life. But not every patient needs, wants or has access to formal contact with a psychologist. What’s more, all members of a multidisciplinary team are likely to experience the impact of psychological matters on their daily practice with patients and colleagues, whether or not their role is to explicitly address those. This series of articles aims to summarise some of the ‘big ideas’ in psychology and translate them into practical advice to promote psychologically informed practice for those providing palliative care, whether as doctor, nurse, allied health professional or in any other clinical or nonclinical role. The first article in the series looks at attachment theory.