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Brief Engagement and Acceptance Coaching in Community & Hospice Settings

 

   

 

The BEACHeS study was funded by Macmillan Cancer Support (Grant #6488043), and ran from 2018 to 2019. You can read a summary of the work below, and we will soon post download links to our full end of project report and intervention manual. Our team are currently working on proposal to secure funding for BEACHeS II where we hope to feasibility test a full clinical trial of this intervention.

Globally, over 14 million new cases of cancer are diagnosed each year, and 8.4 million deaths were attributed to cancer in 2012 alone [1]. Finding out that cancer is no longer curable can be psychologically distressing for both patients and their family [2]. The subsequent referral and transition into specialist palliative care services can be a time of uncertainty and fear. Some patients are reluctant to plan for their future [3] and quality of life is often negatively affected [4].

Acceptance and Commitment Therapy (ACT) is a cognitive behavioural therapy [5] with a good evidence base for the type of psychological problems often reported by people affected by cancer, for example, anxiety and depression [6], but specific evidence for its effectiveness in palliative cancer populations is lacking and limited [7]. Our study aimed to develop and pilot test a brief, manualised form of ACT to support people with cancer that can’t be cured as they transition into palliative care.

Our investigation used a mixed methods design. Following an extensive period of intervention development using both literature search and internal reviewing by our steering group, we tested this on a group of ten patients who had been referred to a Marie Curie hospice for community care and support. We tested the initial efficacy and acceptability of the intervention using a single-case experimental design study [8], supplemented with qualitative interviews with patients, and focus groups with hospice staff. Our intervention was delivered over five one-to-one sessions in the hospice setting. Following data collection, we used participant feedback to update the intervention manual. This was then subjected to external and independent peer review before finalising content for future research and clinical practice.

Feedback on our intervention manual was overwhelmingly positive. Experts saw the value in it, and commended that we had tailored the content to fit the needs of this patient group. The emphasis towards moving forward in the palliative phase of illness openly, values-led, and with a life-affirming stance were viewed as positives. Participant feedback also confirmed the suitability of the intervention. Although there were some challenging aspects to it, participants appreciated the change to talk though their worries and to “…face up to the[ir] death with dignity.”

Of the ten participants recruited into our study, four died part-way through the intervention and one dropped-out. Five participants completed the intervention. Our data did not demonstrate significant effects, though in some ways this is to be expected given our sample size and design. Despite this, there were improvements in some aspects of quality of life, and in some participants were able to map these to delivery of certain intervention modules. Distress remained stable suggesting that our intervention might have buffered against increased distress at this time of physical health deterioration.

Our study design did not work as well as we had hoped. The transition point into palliative care is less clearly defined than anticipated.  As such, our participant approach and inclusion criteria resulted in a much lower rate of participant recruitment than we had expected. There were psychometric problems with some of our measures. We did, however, demonstrate feasibility of intervention delivery, including training competent delivery with fidelity to the manual, and we had acceptable attrition rates, levels of missing data, and pull-through to qualitative interviews. Focus groups with staff recommended a number of possible changes to the design of the work for future trials, some of which will likely be implemented into the next phase of our work.

 

For more information, please contact the Principal Investigator, Prof Nick Hulbert-Williams at n.hulbertwilliams@chester.ac.uk.

 

[1] Cancer Research UK, https://www.cancerresearchuk.org/health-professional/cancer-statistics/w..., Accessed [September] [2018].

[2] Richardson EM, Scott JL, Schüz N, Sanderson K, Schüz B. (2017). 'it was all intertwined': Illness representations and self-management in patients with cancer and anxiety/depression. Psychology & Health, 32(9), 1082-1108. doi:10.1080/08870446.2017.1324970.

[3] Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. (2007). Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management, 34(4), 393-402. doi:10.1016/j.jpainsymman.2006.12.009.

[4] Hwang I, Keam B, Yun Y, Ahn H, Kim Y. (2015). Quality of life changes and intensive care preferences in terminal cancer patients. Palliative & Supportive Care, 13(5), 1309-1316. doi:10.1017/S147895151400131.

[5] Hayes SC, Strosahl KD, Wilson KG. (2001). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press. 

[6] A-Tjak JGL, Davis ML, Morina N, Powers MB, Smits JAJ, Emmelkamp PMG. (2015). A metaanalysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84(1), 30-36. doi:10.1159/000365764.

[7] Hulbert-Williams N, Storey L, Wilson K. (2014). Psychological interventions for patients with cancer: Psychological flexibility and the potential utility of Acceptance and Commitment Therapy. European Journal of Cancer Care, 24(1), 15-27.

[8] Heyvaert M, Onghena P. (2014). Randomization tests for single-case experiments: State of the art, state of the science, and state of the application. Journal of Contextual Behavioral Science, 3: 51-64. n was delivered over five one-to-one sessions in the hospice setting. Following data collection, we used participant feedback to update the intervention manual. This was then subjected to external and independent peer review before finalising content for future research and clinical practice.