• Acceptance and Commitment Therapy (ACT) Enhanced Communication Skills: development and evaluation of a novel training programme

      Hulbert-Williams, Nicholas J; Hulbert-Williams, Lee; Patterson, Pandora; Suleman, Sahil; Howells, Lesley; University of Chester; Canteen Australia; University of Sydney; St George's University Hospitals NHS Foundation Trust; Maggie's Cancer Centres
      Background: Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently-developed interventions such as Acceptance and Commitment Therapy (ACT). Aims: We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach. Method: We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data was collected from 53 participants (at either two-week or three-month follow-up, or both) using self-report survey including both quantitative and free-text questions. Results: At two-week follow-up, 73% of trainees rating our course as having relevance to their work, and at three-month follow up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff wellbeing. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility. Discussion: Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.
    • Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): Results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer.

      Hulbert-Williams, NJ; Norwood, S; Gillanders, D; Finucane, AM; Spiller, J; Strachen, J; Millington, S; Kreft, J; Swash, B; University of Chester; The University of Edinburgh; Marie Curie Hospice Edinburgh (BMC, 2021-06-25)
      Objectives: Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods: Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results: At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions: This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting.