Supporting the patient and accessing support services

1
Supporting the patient and accessing support
services

• Suzanne Mc Keever
• Nurse Specialist
• Psycho-Oncology

2
Objectives

• Raise awareness of NICE guidance
• Raise awareness of incidence of psychological
  morbidity
• Consider risk factors for depression
• Responding appropriately

3
Emotional impact of diagnosis

• Fear
• Distress
• Uncertainty
• Loss of control
• Anger

4
NICE Guidelines 2004
Level group assessment intervention
1 All health and social care professionals Recognition of psychological needs Effective information giving, compassionate communication and general psychological support
2 Health and social care professionals with additional expertise ( e.g. clinical nurse specialists, GPs) Screening for psychological distress Psychological techniques such as problem solving
3 Trained and accredited professionals Assessment of psychological distress and diagnosis of some psychopathology Counselling and specific psychological interventions such as anxiety management and solution focused therapy, delivered according to a specific psychological framework
4 Mental health specialists Diagnosis of psychopathology Specialist psychological and psychiatric interventions such as psychotherapy, including cognitive behavioural therapy
5
Psychological morbidity prevalence and
recognition in cancer

• 9-58 of cancer patients develop an affective
  disorder requiring intervention
• Fallowfield et al 2001,
• Massie et al 2004 Burgess et al 2005
• Oncologists fail to identify majority (60-100)
  of patients with probable psychiatric morbidity
• Sharpe et al 2004 Parle et al 2001
• Less than half of those patients recognised as
  depressed are treated
• Fallowfield et al 2001 Lloyd-Williams and
  Freidman 2001
• Passik et al 1998

6
Psychological Morbidity

• 1 in 10 patients will suffer psychological
  distress severe enough to warrant specialist
  psychological/ psychiatric services (level 4), as
  will 10 to 15 of patients with advanced/
  terminal disease
• 15 of patients will require level 3 service
• Patients and relatives should be assessed at key
  points along the patient pathway

7
Can we tell who will get depressed ?
8
Illness-related Concerns

• Number and severity of patients concerns
  predicts
• High levels of emotional distress
• Affective disorder
• Weisman Worden 1977,
  Harrison et al 1994 Parle et al 1996
• Yet up to 60 of concerns remain undisclosed in
  hospice setting
• 
  Heaven Maguire 1996
• 80 concerns remain undisclosed in inpatient
  setting
• Farrell et al 2005

9
Tailoring information

• Patients who feel they are given inadequate
  information (too little or too much) at time of
  diagnosis are at greater risk of affective
  disorders
• Fallowfield et al 1990, Butow
  et al 1995
• Schofield et al 2003
• History of depression

10
Shared decision making

• Associated with increased compliance with
  treatment, more favourable outcomes and greater
  satisfaction
• Eisenthal et al1979 Schulman 1979 Brody et al
  1989
• Approx 33 newly diagnosed patients fail to
  achieve their desire level of involvement
• 
  Gattellari et al 2001

11
What is depression?Definition

• A condition characterised by persistent low
  mood, the absence of a positive affect (loss of
  interest and enjoyment in ordinary things and
  experiences) and a range of associated, cognitive
  physical and behavioural symptoms.
• NHS Clinical Knowledge Summaries 2010

12
What is depression?Defining characteristics

1. Depressed mood
2. Loss of interest or pleasure
3. Significant weight loss/increased appetite
4. Insomnia or hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or
   inappropriate guilt
8. Diminished ability to think or concentrate or
   indecisiveness
9. Recurrent thoughts of death

13
Making a diagnosis

• Symptoms 1 or 2 must be present
• 5 or more of the symptoms must be present
• Present for most of the day for at least 2 weeks
• Represents a change from previous functioning

14
How do we identify patients with depression

• During the last month have you often been
  bothered by
• feeling down, depressed or hopeless?
• having little interest or pleasure in doing
  things?

15
How do we identify patients with depression

• If yes
• Requires a mental health assessment
• If not competent in mental health assessment
  refer on to an appropriate professional consider
  GP, specialist mental health services.

16
How do we identify patients with depression

• Consider using a screening tool
• Hospital Anxiety and Depression Scale (HADS)
• PHQ-9

17
Suicide Risk

• Not asking is not an option
• Need to find out the extent of the suicidal
  thoughts
• If the patient presents a considerable immediate
  risk refer them urgently to specialist mental
  health services
• Get advice GP, specialist mental health services

18
Why is it so difficult ?
19
Concerns about impact on patient

• Uncontrollably upset
• Angry and shout
• Run out of the room
• Refuse treatment
• Go silent
• Start asking difficult questions
• That we may make things worse

20
Concerns for ourselves

• Taking up too much time
• Coping with our own emotions
• I wont know what to do about the problems raised
• I may not be able to manage the emotions
  /problems expressed
• Wanting to avoid problems that I cant change
  focus on those I can help with
• I have no support for myself
• I have no-one to refer on to

21
Key messages

• Psychological care is everyones business
• How might this person be feeling and how will
  that influence our interaction
• Ask about concerns
• Ask about previous history of depression
• Think what can I do to help?
• Be confident in suggesting support

22
(No Transcript)