• 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.
    • Evaluating process and effectiveness of a low-intensity CBT intervention for women with gynaecological cancer (the EPELIT Trial)

      Hulbert-Williams, Nicholas J.; Hulbert-Williams, Lee; Flynn, Ryan J.; Pendrous, Rosina; MacDonald-Smith, Carey; Mullard, Anna; Swash, Brooke; Evans, Gemma; Price, Annabel; University of Chester; North Wales Cancer Treatment Centre; Ysbyty Gwynedd; Addenbrooke's Hospital Cambridge (F1000Research, 2021-03-29)
      Background: Improving survival from gynaecological cancers is creating an increasing clinical challenge for long-term distress management. Psychologist-led interventions for cancer survivors can be beneficial, but are often costly. The rise of the Psychological Wellbeing Practitioner (PWP) workforce in the UK might offer a cheaper, but equally effective, intervention delivery method that is more sustainable and accessible. We aimed to test the effectiveness of a PWP co-facilitated intervention for reducing depression and anxiety, quality of life and unmet needs. Methods: We planned this trial using a pragmatic, non-randomised controlled design, recruiting a comparator sample from a second clinical site. The intervention was delivered over six-weekly sessions; data were collected from participants at baseline, weekly during the intervention, and at one-week and three-month follow-up. Logistical challenges meant that we only recruited 8 participants to the intervention group, and 26 participants to the control group. Results: We did not find significant, between-group differences for depression, quality of life or unmet needs, though some differences at follow-up were found for anxiety (p<.001). Analysis of potential intervention mediator processes indicated the potential importance of self-management self-efficacy. Low uptake into the psychological intervention raises questions about (a) patient- driven needs for group-based support, and (b) the sustainability of this intervention programme. Conclusions: This study failed to recruit to target; the under-powered analysis likely explains the lack of significant effects reported, though some trends in the data are of interest. Retention in the intervention group, and low attrition in the control group indicate acceptability of the intervention content and trial design; however a small baseline population rendered this trial infeasible in its current design. Further work is required to answer our research questions, but also, importantly, to address low uptake for psychological interventions in this group of cancer survivors.
    • Evaluating the impact of COVID-19 on supportive care needs, psychological distress and 3 quality of life in UK cancer survivors and their support network.

      Hulbert-Williams, Nicholas J.; Leslie, Monica; Hulbert-Williams, Lee; Smith, Eilidh; Howells, Lesley; Pinato, David J; University of Chester; Maggie's Cancer Centres; Imperial College London
      Objectives: The COVID-19 pandemic is having considerable impact on cancer care, including restricted access to hospital-based care, treatment and psychosocial support. We investigated the impact on unmet needs and psychosocial wellbeing. Methods: 144 participants (77% female), including people with cancer and their support networks, were recruited. The most prevalent diagnosis was breast cancer. Forty-one participants recruited pre-pandemic were compared with 103 participants recruited during the COVID-19 pandemic. We measured participants’ unmet supportive care needs, psychological distress and quality of life. Results: Half of our patient respondents reported unexpected changes to treatment following pandemic onset, with widespread confusion about their longer-term consequences. Although overall need levels have not increased, specific needs have changed in prominence. People with cancer reported significantly reduced anxiety (p=.049) and improved quality of life (p=.032) following pandemic onset, but support network participants reported reduced quality of life (p=.009), and non-significantly elevated anxiety, stress and depression. Conclusion: Psychological wellbeing of people with cancer has not been detrimentally affected by pandemic onset. Reliance on home-based support to compensate for the lost availability of structured healthcare pathways may, however, explain significant and detrimental effects on the wellbeing and quality of life of people in their support and informal care networks.
    • What are the experiences of cancer care in gay, lesbian and bisexual patients, and how do these differ from heterosexual cancer patients

      Hulbert-Williams, Nicholas J.; Plumpton, C.; McHugh, Rhian; Semlyen, Joanna; Flowers, Paul; Storey, Lesley; Rearn, Emma; Neal, Richard; University of Chester ; Bangor University ; University of Chester ; London Metropolitan University ; Glasgow Caledonian University ; Queen's University, Belfast ; King's College, London ; Bangor University (Wiley, 2015-04-28)
      Lesbian, gay and bisexual (LBG) people frequently experience inequality within healthcare, and are an underserved population in cancer research.