ICCN 17

Training in psychosocial oncology

Dr Deborah McLeod – Dalhousie University, Halifax, Canada



Can you tell us about your presentation?

Screening for distress has become the sixth vital sign, it has been endorsed by a number of international organisations including the Union for International Cancer Control and many others. This programme was part of the Canadian initiative funded by the Canadian Partnership Against Cancer and we basically designed an online programme similar to many others. I also lead a project called the Inter-professional Psychosocial Oncology Distance Education Project, the IPOD project, and we’re very concerned as an organisation, CAPO, that there are lots of opportunities to train healthcare professionals in psychosocial oncology. So we’ve had a long-standing project in developing options; the screening for distress option was a little bit different, it was an independent study programme, it was designed for five or six hours for learners to participate in to given them some high level background about screening – what is it, why is it important and, most importantly, once you’ve screened what do you do? So a good portion of the education programme was around modelling therapeutic conversations with patients and family members about this screening score on the piece of paper. So the screening score by itself is like an indicator but one needs to understand what it means to the patient, so how do you have a conversation with someone about what that means? The other aspect was really wanting to stretch particularly nurses as the key screeners, certainly in our country, to stretch them so that they were actually practising to the full scope of their licensure. So that meant providing content on supportive care and supportive counselling, there was a good section in the middle.

So what we found, we’ve had 500-600 people participating in this course, it did take most people 5-6 hours to complete it, we did a matched pairs pre-post analysis with the subset and we found that, based on self-report, the course completers identified that their confidence around a lot of elements related to screening increased. They felt more comfortable doing the screening, having conversations about it, dealing with psychosocial concerns, dealing with things like anxiety, depression, grief and those sorts of things. Then in the qualitative feedback they also reported a lot of benefits – confidence, it gave them a structure to think about that work and screening. Sometimes it validated what nurses were already doing and said, “Yes, it just gives me more confidence that what I’m doing is the right thing.” I think the key thing that was very effective was that it was an independent study, it was readily available, they could sign in and out of it, use it whenever they wanted and we used a lot of videotape, not long ones but brief ones, showing the kinds of skills that we were talking about in the education programme. Those were very highly valued, they were ones, that kind of process that we use with online education more globally in the IPOD project. So that’s basically what it was all about.

Who was this programme for?

Anyone, and not only nurses but any health professional. So there were other people that took the programme as well; the vast majority, I think 66-67% of our participants, were nurses but we also had dieticians who did it, we had social workers who did it, spiritual care providers and who would comment that, “You know what? This gives me a really good structure to think about these conversations in my practice, to be alert for those certain kinds of things, to do screening if I feel the need to do it.”

Are there any particular screening tools used?

There’s a standardised tool in Canada called the Canadian Distress Tool, I believe that’s the correct title. It includes the ESAS, the Edmonton Symptom Assessment Survey; it includes the Canadian Problem Checklist and some jurisdictions will add another item or two, for example in my own jurisdiction in Nova Scotia we also use the Distress Thermometer, but the minimum data set for Canada is the ESAS and the Canadian Problem Checklist and that’s standardised.

Could this programme be used in other areas or countries?

In fact there are many other countries that are launching their own screening programmes and each country is using slightly different tools, I think there is some gathering consensus about the areas that need to be assessed but there are a number of tools that will do the job. So different jurisdictions are doing slightly different processes but there are screening processes well underway in Australia, for example, some parts of Europe for sure; I'm hearing about some presentations in Africa, which is terrific, and many other parts of the world.

So this is a good method for disseminating education?

It does seem to be very effective but it doesn’t take the place of local education so this is a high level educational intervention, people who participate in it also need support, guidance, clinical supervision, probably more education about the local context in order to really move with it. So it was to provide a national level resource so it has both its pros and its cons, it doesn’t do the whole thing.

Any plans to provide education in other areas?

In fact, the same kind of process is being used for the IPOD project more broadly. So that project is a collaboration among ten universities in Canada and it’s certainly only about psychosocial oncology, which was CAPO’s interest. We do have several topics, we do have a basic course for graduate students in psychosocial oncology which is thirteen weeks; we have a course called Relational Practices with Families in Oncology and Palliative Care; we launched last year courses in sexual health and sexual health counselling and we’re about to launch another course which is a knowledge translation intervention around clinical practice guidelines related to distress management. So those are all in process, they certainly could be adapted for people with other diseases although no-one has expressed an interest in doing that. There are other kinds of programmes that are around as well but it’s really an effective way to increase opportunities, not only for university students but also for practising health professionals, because we can gather people online from all over the country, the world and isolated areas, small universities where people don’t necessarily have much access to specialty courses and we also are able to create opportunities for inter-professional education, which is a very key part of this. It makes a big difference when social workers and nurses and spiritual care providers, for example, learn together, they really help each other.