There is increasing recognition of the emotional dimensions of the cancer experience, and in Australia a number of resources have been developed to enhance health professionals’ ability to provide psychosocial support for patients. Unfortunately patients with advanced cancer are not well-served in terms of resources, most of which focus on early disease and survival. Children of parents with advanced cancer face a considerable burden, but parents may avoid discussion with their children, partly because they wish to protect them from distress, partly because of lack of support and limited access to information to guide them in this challenging task. There are limited numbers of health professionals with the psychosocial knowledge and skills to assist parents, and they are largely confined to metropolitan centres, making timely and equitable access to appropriate information and support for parents a major problem. Improving access to information and support could be achieved through extension of existing educational and supportive roles of a variety of health professionals. However health professionals may avoid discussion about emotionally-challenging issues because of perceived lack of training, and low professional confidence. Avoidance is also known to be a common defence mechanism for health professionals who find that the burden of caring arouses painful and sad feelings. Professional education has traditionally not encouraged reflection on the emotional dimensions of work, or assisted in the development of coping strategies. The aim of this study was to develop and evaluate the effectiveness of an educational intervention to enhance the capacity of health professionals to provide timely, evidence-based information and support for parents with advanced cancer, to guide them in talking with their children. Selection of oncology nurses for this purpose was based on their accessibility across treatment settings, their existing skills in education and support, and the fact that patients find supportive care provided by nurses highly acceptable. The study employed mixed methods across several phases to achieve this aim. In the first instance, relevant literature was used as a framework for developing an educational intervention. Qualitative methods were used to refine the educational intervention: - focus groups with oncology nurses examined perceptions of their supportive care roles including barriers and educational needs, and critical feedback was sought from a group of nurse experts regarding the scope and style of the intervention. This data informed the development of the final intervention which comprised a self-directed educational manual and day-long interactive communication skills training workshop, supplemented with a brochure for parents with advanced cancer. The brochure was developed in response to nurses’ expressed need for written resources to support them in their interactions with parents with advanced cancer. The brochure was based on relevant literature and refined using information gathered through in-depth interviews with parents with advanced cancer. A quasi-experimental design was used to evaluate the effectiveness of the intervention using pre and post-measures. Thirty-five oncology nurses were recruited from three oncology centres in Brisbane, three withdrawing prior to completion of the educational intervention. Nurses’ stress, burnout and psychological morbidity were assessed by structured measures; attitudes and confidence were assessed by study-developed questionnaires. Knowledge was assessed by examination of nurses’ responses to two clinical vignettes describing a parent requesting help from the nurse about how to respond to their child. Changes in communication skills were evaluated by video-taped interviews with simulated cancer patients trained to deliver a number of scripted cues. Following participation in the educational intervention there were significant improvements in nurses’ self-reported confidence in ability to provide information and support for parents with advanced cancer, and initiate discussion with parents about emotionally-challenging topics. After the intervention nurses were significantly more likely to take an active role in self-care strategies. There were significant improvements in generic communication techniques and communication skills specific to this study: emphasising to a parent the importance of open communication with their children; confidence in responding to an overtly distressed patient, and openly discussing poor prognosis. Analysis of responses to the vignettes revealed significant post-training reduction in focus on practical issues, reduced referral of the parent to other health professionals, and significant increases in empathic engagement and supportive advice likely to assist the parent to respond to their child. There were no changes in stress and burnout or psychological morbidity. The response rate for an acceptability survey was low, but respondents enthusiastically endorsed the educational intervention, describing changes in clinical practice: improved listening; increased engagement with patients about emotional concerns, and reduced avoidance of potentially-distressing discussion. Study participants were a self-selected group which may not be representative of all oncology nurses, meaning that the results of this study many not be generalisable. Hence the next step is a randomised controlled trial, in which the evaluation is expanded to include an examination of parental satisfaction with a brief supportive intervention delivered by a trained nurse, using structured measures of family adjustment.
| Identifer | oai:union.ndltd.org:ADTP/254031 |
| Creators | Dr Margaret Turner |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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