The purpose of the group is to help patients who struggle to do the 'living' and 'surviving' with cancer.
In line with the NICE guidance CSG4, it aims to provide emotional support and practical advice once the treatment is complete and aims to help patients overcome the apprehension caused by not having on-going hospital treatment.
Aims and objectives
The main aim of the cancer survivors group is to help patients who struggle with the transition from active treatment to 'survivorship' which is highlighted as one of the most psychologically demanding phases of the patient pathway.
- To provide emotional support once active treatment is complete
- To sign post to services that can provide practical help once active treatment is complete e.g. Citizens Advice Bureau, Sexual health counselling, complementary therapies
- To come together as a group to normalise the feelings of loneliness and recognise that most cancer 'survivors' struggle.
Reasons for implementing your project
Clinical Nurse Specialists identify patients who they feel are struggling by undertaking the Hospital Anxiety and Depression Scale (HADS) or the Distress Thermometer. The clinical psychologist assesses the patients for appropriateness to the group. Qualitative feedback is gained at the end of each group session.
There are 8 group sessions consisting of the following:
Session 1 : Patient experience of diagnosis - Why me? finding meaning, emotions, living with uncertainty, abandonment issues
Session 2: What is pain, fatigue and cancer, feelings you may have, diet, exercise and sleep when coping with fatigue, role of complementary therapies
Session 3: Assertiveness training, communication, self esteem and confidence issues
Session 4:Coping with stress and anxiety after cancer, thinking errors, look good feel better, physical activity trainers Session 5: Sex, relationships and cancer, role changes, relationship issues, body issues, lymphoedema nurse
Session 6: Coping with chronic illness, care partners also need to take care of their own self. Emotional effects of cancer Session 7: Finances: Support groups and additional resources, taking control and living with uncertainties
Session 8: Follow Up after 2 months. The HADS is completed at sessions 7 and 8 for post measure evaluation.
At the follow up session, 2 months after the end of the group, a qualitative measure is also incorporated.
How did you implement the project
The group was implemented by inviting the patients to take part in the group to normalise some of their psychological / emotional reactions.
A leaflet was given offering more information about the group and the content. Any resistance from the patient perspective was overcome by introducing them to the relevant professionals delivering the group prior the actual group itself.
There was some resistance in setting up the group in terms of the venue and the catering provisions of tea and coffee which was overcome by the help of the Public Health department in Walsall. The clinical nurse specialists had not delivered groups before. The lack of experience was overcome by familiarising them with the content and ongoing support in the form of clinical supervision by the clinical psychologist. Without the support of the clinical nurse specialists the group would not be so well received and would not succeed. Clinical nurse specialists from other sites sometimes didn't refer patients to the group. However having completed two groups and beginning a third now, this has convinced them of the benefits to the patients. The attached report highlights the success of the group.
Reduction in anxiety and depression was evaluated by gaining a baseline measure when first referred for the group to end of group and then again at follow up session.
The main outcomes are reduction in anxiety and depression as measured by the HADS scale. Also as important are the qualitative factors whereby patients report changes in being able to take on the challenges of daily living and restore relationships.
This is evident by a patient stating "The overall impression of the group is good for everybody concerned as it gives the people a chance to express their inner most feelings which they probably cannot express their feelings to loved ones who would probably get upset knowing how they really feel."
When asked in a qualitative question whether patients would recommend the group, a representative comment was "I definitely would recommend this group to other patients as it gives people time out to express their feelings their doubts and fears out into the open and share it with other people."
The results are currently in the process of being written up and will then be shared and published with Macmillan who are very supportive of this group. Please see the attached report which now highlights the success of the group and provides in depth information of the outcome measures.
Key learning points
A group format definitely helps to deliver emotional support whereby patients can then learn to support one another. A pitfall to avoid is that the group does not become a support group as it is professionally led. With it being professionally led, a variety of topics can be introduced and delivered with a clinical intervention. A support group may naturally be borne out of the group at the end as patients become familiar with one another.
Qualitative feedback which includes the following comments:
"Gives me hope that things will get better, gives me hope that more is being done, shows that I can move on a little". . ."It helps me put my feelings into perspective. I tended to think I was over the top with what I am experiencing but it is now apparent that I am not on my own".
Other cancer survivors are having the same doubts/fears/feelings:
"Very informal, relaxing, giving care to individual people's needs, helped me feel better today. Feel much lighter in my mind. Am not leaving loaded with other people's problems"
"I realise I need to take control as things will never change if I don't say how I am really feeling" .
"I have learned that no one gives me permission to take time out for myself. I can give myself permission. If you take time to look better on the outside, feeling better inside will follow"
"I can be honest and everyone in the room can relate to me. People/family doesn't seem to understand."