Psychological interventions in palliative care: a practitioner / researcher network for developing and evaluating novel treatments.

  • Gillanders, David (Principal Investigator)
  • Monteiro da Rocha Bravo Ferreira, Nuno (Co-investigator)

Project Details

Description

This project will bring together an interdisciplinary network of practitioners in palliative care with University of Edinburgh practitioner researchers in behavioural science to develop and evaluate a novel form of psychological care for people facing terminal illness. The knowledge exchange will involve training the palliative care practitioners in behavioural interventions such as acceptance and mindfulness. Our previous research has shown the value of these interventions in other health conditions; applying them in this novel area will extend and enhance the impact of our previous research. The intervention will reduce psychological suffering, improve quality of life and help people to make valued choices at end of life. The strength of this project is the synthesis of clinical experience in palliative care with empirically proven behavioural science to reduce psychological suffering for people with terminal illness.

Layman's description

The University hosted two events that brought together people who work in palliative care, providing support and therapy for people who are dying and their families. Over thirty people came from around the UK from a mix of professional backgrounds. The events shared skills and understandings. They brought together experience of working with dying people, with clear psychological science, to develop better interventions and to generate ideas about how to scientifically evaluate them.

Key findings

Over thirty people attended from a variety of backgrounds. We sampled them using a simple survey after the events and found 100% agreement that participants felt the time was well spent, the events were well organised and were professionally stimulating. We gathered specific qualitative comments from participants about what had changed for them as a result of their attending these events here is that feedback:
The following things have developed or changed due to my involvement with the ACT in Palliative Care Network (e.g. developing new tools, preparing grant applications, delivering new teaching, further reading or practice, continued networking / talking)
1. My involvement in the ACT in Palliative Care Network has provided an extraordinarily valuable catalyst in defining the concept of 'supportive conversation' in Maggie's, and then support and train Maggie's Cancer Support Specialists to undertake such conversations.
2. using outcome measures, strengthening professional links, improving teaching materials
3. I have developed ideas about how ACT can be used in a palliative setting, particularly from the sharing of clinical ideas e.g. metaphors, and making clear links between clinical approaches and underlying theory of ACT. We have incorporated more ACT congruent teaching into our psychological skills training with non psychologist colleagues.
4. The research network helped me form relationships with professionals with similar interests and set up two research studies. Both of these studies were generated by ideas formed within the ACT in palliative Care Network Meetings in Edinburgh. As a network we discussed the importance of supporting teams working within supportive and palliative care settings and developing appropriate training. To be able to do this we discussed the importance of understanding the team’s needs to tailor our interventions more effectively. In response to this gap in understanding I have set up a qualitative study looking at the training and support needs of palliative care professionals. Although no results are available yet we hope it will increase our understanding of ways psychology can better support and train other team members.
5. They have increased the support available for generating ideas and given me the confidence to establish research studies. Additionally, the network agreed to work together to evaluate teaching and training more formally which resulted in more helpful service evaluation
6. Continued talking with group interested in evaluating ACT in reducing staff burnout.
7. General networking in being kept up to date with current research development
8. It was quite a time commitment to travel up to Edinburgh from the Midlands but I felt it was well worth my time.
9. It was so helpful to make links with other Clinical Psychologists who work in the same speciality and use similar approaches and models to myself. I have continually gone back to the conversations and discussions we had on those two days as they have helped further my thinking both clinically and research wise.
10. I have made good links with new colleagues and kept in touch and shared resources, learning and information. It has prompted me to engage with and develop new ideas and initiatives with both staff and patients in my place of work.
11. I believe these two days have helped me develop my confidence and competence in my clinical work with palliative care patients and staff and for that I am ever grateful.
12. The network provided a good opportunity to meet colleagues outside my own organisation working with the same client group and with an interest in ACT. Being a clinician it was useful to meet other clinicians and share ACT-based metaphors and tools relevant to the psychological challenges for people we see in palliative care. I have specifically used and integrated these tools into my individual and group clinical work. I ran a skills sharing session with the team of Cancer Support Specialists I work using ACT tools to help with patients they feel "stuck" with. I have recently set up a supervision group for NHS Clinical Nurse Specialists and a group for specialist Radiographers, both of which are going to be informed by an ACT framework. This network helped me initiate these groups and I hope will continue to inform my work with other professionals.
13. We were given plenty of notice and clear instructions prior to the meetings.
14. I found it invaluable to be able to be in a room with like minded people, all embracing core humanitarian values in true ACT spirit.
15. Yes, it was great to exchange clinically relevant information, metaphors, and techniques as well as research ideas.
16. The main impact for me has been the professional Networking. I have stayed in contact with the group and exchanged metaphors as they show up in practice, sometimes with the group as a whole and other times with individuals. I will hopefully as a result get some support with analysis of data that I have been collecting in relation to ACT individual treatment and courses.
17. Although the Networking meetings are still in the 'seedlings' stage I can see several strands developing in the future and hope to be part of the group and help it secure further funding for research projects, training and so on. The core ethos of the ACT movement is very much held within the group dedication "to the advancement of functional contextual cognitive and behavioral science and practice so as to alleviate human suffering and advance human well being"
Other developments since the Palliative Care Network Meetings
1. Since these meetings David Gillanders has delivered further training to interdisciplinary staff working in this setting, across the UK, as have other members of the network, notably Dr Ray Owen, Prof Nick Hulbert-Williams and others.
2. We have submitted one grant application (unfortunately unsuccessful) to pilot a feasibility study in Bradford (Samantha Masely, NHS Bradford District Care Trust, Collaborating with David Gillanders, UoE and Maria Horne, University of Bradford)
3. We have successfully bid for a University of Chester grant (£10,000) to undertake a longitudinal study of Cancer Survivorship to investigate how acceptance and mindfulness processes impact on people after recovering from cancer. This will help us to understand better the differences between cancer survivorship and palliative care.
Title: Psychological transition after primary cancer treatment- component mapping and intervention planning using Acceptance and Commitment Framework
•Prof Nick Hulbert-Williams (University of Chester)
•Dr Brooke Swash (University of Chester)
•Dr David Gillanders (University of Edinburgh)
•Dr Lesley Storey (Queen’s University Belfast)
•Dr Pandora Patterson (CanTeen/ University of Sydney)
•Dr Fiona McDonald (CanTeen/ University of Sydney)
•Dr Sylvie Lambert (McGill University, Canada)
•Ms Melissa Pilkington (University of Chester)
4. We have secured a PhD student to work with David Gillanders, Nuno Ferreira and Marie-Curie Hospice Edinburgh. This is Shaun Fisher and his work is in understanding burnout and stress in people who work in palliative care settings.
We have secured a further PhD student, Benjamin Ramos, who will be investigating how informal caregivers cope with caring for a relative who is dying.
5. Marie-Curie Hospice Edinburgh have secured additional funding to help some of their lead medical staff to attend regular reflective practice / clinical supervision sessions with David Gillanders to support their work in this area.
6. Academics Brooke Swash and Nick Hulbert -Williams (University of Chester) have continued to visit UoE and to explore the development of a further funding application for a study of using psychological therapies with patients who are entering the Palliative Care setting.
7. David Gillanders has continued to collaborate with Sari Harenwall (Maggies Newcastle) to support her in analysing routine outcomes of use of ACT within that setting. A poster and an oral presentation of this work has been submitted to the International Conference of the Association for Contextual Behavioural Science.
StatusFinished
Effective start/end date1/01/1531/12/15