References1 National Institute for Clinical Excellence (2004) Supportive and Palliative Care Guidance NICE, London.2. Griffiths J, Ewing G, Rogers M (2010) Moving swiftly on: Psychological support provided by District Nurses to patients with palliative care needs Cancer Nursing 33 (5) 390-397. 3. Griffiths J, Ewing G, Rogers M, Barclay S, Martin A, McCabe J, Todd C (2007) Supporting Cancer Patients With Palliative Care Needs: District Nurses' Role Perceptions Cancer Nursing 30 (2) 156-162. 4. Connolly M, Perryman J, McKenna Y, Orford J, Thomson L, Shuttleworth J, Cocksedge S (2010) SAGE & THYME: a model for training health and social care professionals in patient-focussed support. Patient Education and Counselling 79(1) 87-93. 5. Rogers C (2003) Client centred therapy: its current practice, implications and theory Constable, London. 6. Bandura A (1982) Self-efficacy theory in human agency American Psychologist 37(2) 122-147. 7. Maguire P, Faulkner A, Booth K, Elliott C, Hillier V (1996) Helping cancer patients to disclose their concerns European Journal of Cancer 32a 78-81. 8. McCormack B, McCance T (2006) Development of a framework for person-centred nursing Journal of Advanced Nursing 56(5) 472-479

Improving Psychological Support by District Nurses in Palliative Home Care: A Pilot Study of a Communication Skills Tool

Griffiths, J (1) Wilson, C (1) Ewing, G (2) Connolly, M (3) Grande, G (1)

1 University of Manchester, School of Nursing, Midwifery & Social Work, Oxford Rd M13 9PL, UK; 2 University of Cambridge, Centre for Family Research, University of Cambridge, CB2 3RF, UK; 3 University Hospital South Manchester, Wythenshawe, Manchester, M23, 9LT, UKFindings

Pre-training focus groups

There was a strong interest in basic communication skills training to build on existing experience

‘We’ve had no communication skills training’

‘How do you know there’s not a better way of doing things if you’ve never been trained?’

Immediately post-training focus groups

DNs were very positive about the tool and confident about using it in practice

‘It gives you a structure..and leads you through the questions you need to ask and find out...it gives you a closing as well’

‘We need to listen, give more time, not jump in’ Two month post-training focus groups

All DNs had applied SAGE & THYME in practice. Some followed the mnenonic closely, others used it to facilitate recall of general principles of patient-centredness

‘It’s a bit like self-help really,... encouraging the patient to sort of...reflect on..resolve their own problems’

’You’re not fobbing them off, you’re empowering them in a different way, and they do look quite positive when you leave’

‘The question where you say..who have you got to help you..that was brilliant..that brought a lot more information’

Conclusion

Perceived benefits of SAGE and THYME

•Facilitates opening and closing of conversations and offers structure for consultations•Aids recall of patient-centred communication•Encourages DNs to hold back with giving advice •Allows patients to find own solutions •Improves DNs’ confidence in their communication skills

Implications

Training in SAGE & THYME in a 3 hour workshop appears to be an efficient and cost-effective way to improve communication skills of DNs working with cancer patients

Future research is needed to assess how DNs use the tool in practice and to determine any benefits of the tool for patients

Background

In the UK, most cancer patients spend their last year of life at home, supported by District Nurses (DNs). A component of DNs’ work is psychological support1. However, research shows that many cancer patients have unmet psychological needs and DNs find psychological support difficult 2,3. Connolly et al4 have developed an evidence based 5- 8communication skills tool taught in a 3 hour workshop that addresses concerns about managing the psychological needs of cancer patients. The tool uses the mnemonic SAGE & THYME to guide practitioners through patient centred assessment and simple problem solving.

Aim

To train DNs in SAGE & THYME and explore its utility with cancer patients in the home care setting.

Method

DNs were interviewed in 4 focus groups of 4-10 participants on 3 occasions: pre-training, immediately post-training and two months post-training to discuss perceptions of the utility of SAGE & THYME before and after its use in practice.

SAGE & THYME

Setting: If you notice concern - create some privacy – sit downAsk: “Can I ask what you are concerned about?”Gather: Gather all of the concerns – not just the first fewEmpathy: Respond sensitively – “You have a lot on your mind”Talk: “Who do you have to talk to or to help you?”Help: “How do they help?”You: “What do YOU think would help?”Me: “Is there something you would like ME to do?”End: Summarise & Close ‘Can we leave it there’?

Data Analysis

Thematic content analysis facilitated by Nvivo software.