Promoting Optimal Outcomes in Mood through Psychosocial Therapies for cancer patients: a randomised trial

Patients who have low to mild distress or who have risk factors for becoming depressed will receive a self-directed resource suite which includes handbooks on coping with cancer, a relaxation CD, information about coping with stress and other information about topics such as sleep hygiene and exercise. Information is included about the availability of support through the Cancer Helpline. Patients who have mild to moderate depression/distress and/or risk factors for becoming depressed and a HADS score of 8 to 21 inclusive will receive tailored psychosocial therapy, aligned with patient needs as identified on patient self-report on the Distress Thermometer. The precise type of psychosocial therapy will vary depending on patient need, examples of which include: i) Practical concerns such as about finances; difficulty with domestic tasks: Therapy may include referral to Social Work; clarification of concerns; structured problem-solving; challenging black and white thinking about the need to perform domestic tasks; re-assigning priorities. ii) Family - concerns about children: Therapy components may include empathic listening; acknowledgment of concerns; explanation about children's needs; discussion about the benefits of maintaining routine; reassuring children that they have not caused the cancer. iii) Emotional concerns, for example anxiety about chemotherapy: Therapy may include explanation and provision of information; identification of automatic thoughts; challenging negative cognitions; relaxation and guided imagery. iv) Physical concerns such as pain: Therapy would include referral for medical review; exploration of concerns about pain; identifying and challenging misbeliefs e.g. about becoming dependent on analgesia or that use of morphine implies inevitably poor prognosis; relaxation and guided imagery. v) Spiritual concerns such as shame about dependence, low sense of worth: Therapy would include dignity-conserving techniques e.g. exploration of past experiences, reflection on strengths; engaging in creative discussion about ways to feel in control; framing assistance as necessary to maintain dignity. The psychosocial therapy will be delivered by health professionals from diverse backgrounds including nursing, radiation therapy or speech therapy who have undergone focused training. The training will be delivered through a structured self-directed educational manual, supplemented with a day-long skill development training session faciliated by one of the psychiatrist investigators at the specific Site. The duration of the training for participating health professionals will be approximately 10 weeks. During the delivery of the psychosocial therapy, all health professionals will participate in weekly clinical supervision conducted in group format with other participating health professionals at the respective Site, facilitated by one of the psychiatrist investigators, in order to monitor progress and ensure fidelity of the psychosocial intervention. The therapy sessions will each be of maximum 30 minutes' duration, for a maximum of 4 sessions, delivered over 4 weeks. The therapy may be delivered face-to-face or by telephone depending on patient and health professional convenience. Patients receiving the psychosocial therapy will also receive the self-directed resource suite described above.