Enhancing psychosocial care for people with cancer in rural communities: what can remote counselling offer?

Rural cancer patients are often disadvantaged in access to psychological services. We reviewed remote counselling research for psychological support using telephone, videoconferencing, and the Internet as a potential solution. Telephone counselling is the most extensively researched, while there are encouraging findings in emerging research about videoconferencing and Internet-based psychological care. Where no face-to-face psychological service exists, these technologies are promising, yet unproven. Less variable methods are needed to better assess the technology and therapeutic approach for stronger evidence.

Lung transplantation in adolescents and young adults with cystic fibrosis.

CONTEXT: Little is known about adolescents' and young adults' experience with cystic fibrosis while waiting for or after receiving a lung transplant. The psychological and psychosocial factors that may influence these patients' transplant outcomes are yet to be fully explored. OBJECTIVE: To explore the psychosocial impact of the lung transplant journey on adolescents and young adults with cystic fibrosis. DESIGN: A questionnaire-based pilot study was used to enable descriptive, comparative, and correlational analyses between pretransplant and posttransplant groups. SETTING: A major lung transplant unit in Australia. PARTICIPANTS: Twenty-seven patients (9 before and 18 after transplantation) participated in the study. The mean ages were 18.7 years (SD 4.2) and 22.6 years (SD 3.9) in the pretransplant and posttransplant groups, respectively. RESULTS: In all domains of the Short Form 36 except Mental Health and Social Functioning, the posttransplant group had significantly higher scores (P < .05) compared to the pretransplant group. The Hospital and Anxiety and Depression Scale total Distress score in the posttransplant group was related to the number of rejection episodes (r = 0.47, P = .049) as well as hospital admissions (r = 0.51, P = .012), The number of rejection episodes was significantly related to patients' perceived level of self-efficacy (P = .025), importance to health (P = .001), and ease (P =.10) of monitoring their symptoms. CONCLUSION: This study provides some insight into the needs of adolescents and young adults with cystic fibrosis and the differences between those who are awaiting a transplant and those who have received a transplant. Assessing the young person's perceptions in relation to activities such as exercising, monitoring symptoms, and taking medications can give helpful insights into the transition phase, but require further research.

Assessing the support needs of women with early breast cancer in Australia.

The purpose of the current study was to access the degree to which the support needs of women with a newly diagnosed, early invasive, primary breast cancer and their families are being met. A random sample of 544 women diagnosed with early breast cancer was recruited to participate in a telephone survey via state and territory cancer registries. Sixteen percent of women reported not receiving enough support during their diagnosis and treatment, and only 65% of these women reported that their families received enough support. The primary sources of support for women and their families were medical practitioners (eg, surgeons, oncologists, and general practitioner) with very few women or family members utilizing mental health professionals. Given the importance of adequate support when being diagnosed and treated for breast cancer, urgent attention needs to be paid to training medical professionals in providing appropriate support and referrals for their patients.

An evidence-based specialist breast nurse role in practice: a multicentre implementation study.

The objective of this study was to examine the feasibility, implementation, acceptability and impact of an evidence-based specialist breast care nurse (SBN) model of care in Australia. Primary data were collected from four diverse Australian breast cancer treatment centres over a 12-month period. The design was a multicentre demonstration project. Information about the provision of care and patient needs was collected through prospective logs. Structured interviews were conducted with women who received the SBN intervention (N = 167) and with a control group of women treated prior to the intervention period (N = 133). Health professionals (N = 47) were interviewed about their experience of the SBN. Almost all women had contact with an SBN at five scheduled consultations and 67% of women in the intervention group requested at least one additional consultation with the SBN. Women in the intervention group were more likely to receive hospital fact sheets and to be told about and participate in clinical trials. Ninety-eight per cent of women reported that the availability of an SBN would affect their choice of hospital, with 48% indicating that they would recommend only a hospital with a SBN available. Health professionals reported that SBNs improved continuity of care, information and support for the women, and resulted in more appropriate referrals and use of the time of other members of the team. In conclusion, the SBN model is feasible and acceptable within diverse Australian treatment centres; there is evidence that some aspects of care were improved by the SBN.

Appraisal and psychological distress six months after diagnosis of breast cancer.

OBJECTIVES: Four in ten women with breast cancer experience high levels of anxiety or depression, despite advances in oncology treatments. The study investigates the role of psychosocial, disease and treatment characteristics, and appraisal processes to better understand factors contributing to this high psychological morbidity. DESIGN: A postal survey was employed to observe psychological morbidity in women 2 and 6 months after initial diagnosis and treatment of breast cancer. The study was conducted as an adjunct to an Australian multi-centre feasibility study of an evidence-based specialist breast nurse (SBN) model of care. METHODS: In total, 195 women with a new diagnosis of early or locally advanced breast cancer completed the data collection relating to this study. Psychosocial, disease and treatment information for each woman at diagnosis was recorded in research logs. Women completed the GHQ-12 questionnaire 2 months after diagnosis, and at 6 months they completed the GHQ-12 and an appraisal process questionnaire designed by the National Breast Cancer Centre (NBCC). Bivariate and multiple regression analyses were undertaken to build a statistical model to account for GHQ-12 scores at 6 months. RESULTS: According to the GHQ-12, 43% of women had a likely affective disorder at either 2 or 6 months after diagnosis. Point prevalence decreased from 2 to 6 months yet remained substantial compared with general population statistics. Psychological functioning in women with breast cancer is related to a woman's psychiatric history, grade of tumour, and her appraisal processes. Most importantly, improved psychological functioning from 2 to 6 months after diagnosis is related to a woman having a lower primary appraisal of threat and a greater secondary appraisal of self-efficacy in terms of having confidence in her own ability to cope with concerns associated with the illness. CONCLUSION: Appraisal processes play a significant role in psychological adjustment to breast cancer. Adjustment may be facilitated by ensuring that the treatment team responds to shortfalls in a woman's appraisal of her illness and her perceived ability to cope, especially where a difficult prognosis is evident.