Liverpool Psychology Service for Cancer Dr Janice Ablett Consultant Clinical Psychologist Professional Lead

The new service is funded by Liverpool PCT in partnership with RLBUHT and the Division of Clinical Psychology at the University of Liverpool, in collaboration with Aintree Hospitals Trust (for Liverpool patients). It builds on existing service provision: Clinical Psychology Fellow in Breast Unit Health Psychology Fellow in nationally funded Ocular Oncology Service.

Prevalence of Psychological Need Surveys indicate that one third to one half of cancer patients experience psychological disorders, with 20-25% reaching ‘caseness’ for depression. In palliative care these figures are higher. British Psychological Society (BPS): 15-30% of patients are sufficiently distressed to require professional help at some point during their cancer trajectory. Psychological morbidity in carers – significant numbers of carers experience psychological distress, in turn affecting their ability to cope & provide support. Clinical staff themselves are at risk of psychological morbidity & burnout.

From diagnosis onwards People experience a range of emotions; shock, fear, anger, sadness , guilt No two patients with cancer show exactly the same emotional response, even if the physical status is very similar. Response depends on the individual perception of the threat of cancer, which is determined by the characteristics of the person concerned. (Holland, 1989). Cancer is a disease shot through with uncertainty, and it is this uncertainty that makes everything so difficult. (Burton & Watson).

Psychological Needs in Cancer People with cancer are at high risk of experiencing psychological difficulties such as: Anxiety Trauma related problem Adjustment disorders Body image problems Depression ANV Interpersonal difficulties Complex pain Insomnia Sexual dysfunction

Psychological needs in cancer Consider referral for those who are: Struggling to adjust over time With intense emotional reactions that compromise their mechanisms for coping and self care Who are ‘stuck’ in a way likely to impair future adjustment With emotional difficulties that are unlikely to resolve over a reasonable time Who need specialist psychological support when involved in complex decision making about treatment

Strategic Context & Drivers The National Cancer Plan (2000) Improving Outcomes Guidance (1999-2006) NICE Guidance on Improving Supportive & Palliative Care for Adults with Cancer (2004) MCCN Review of Psychological Services (2007) The National Cancer Peer Review Programme (2009-2010) Cancer Reform Strategy; achieving local implementation (2009) National Cancer Survivorship Initiative (NCSI) vision (2010)

The local picture Liverpool is the Cancer Capital of Europe with a mortality rate of 237 deaths per 100,000 and the highest level of cancer incidence in England. Liverpool Primary Care Trust has been identified by the National Health Inequalities Programme as being one of 13 PCTs in England that contribute the greatest number of deaths by cancer.   Liverpool Primary Care Trust, Nov 2009.

New Service PCT funded posts: Dr Jan Ablett Consultant Clinical Psychologist/Professional Lead Dr Helen Beesley Principal Clinical Psychologist Senior Clinical Psychologist appointed Dr Joanna Omylinska-Thurston Counselling Psychologist Mrs Susan Clark PA/Secretary University posts: Dr Louise Clark Clinical Psychology Fellow, Breast Unit Ms Laura Hope-Stone Trainee Health Psychology Fellow, Ocular Oncology Mrs Helen Ullmer Assistant Psychologist, Breast Unit MCCN: Mr Rob Dinwoodie Assistant Clinical Psychologist; Information/leaflet study

A psychological service focussed on: Alleviating psychological distress Improving well-being Person-centred care Respect & dignity Needs assessment (rather that distress management) Prevention (& identifying vulnerabilities) Improving quality of life Cost effectiveness

Liverpool Psychology Service for Cancer: Level 4 – NICE guidance Provide specialist psychological care for patients with severe distress and complex needs Draw on a multi-theoretical base to inform assessments & interventions that are specifically tailored to individual need Ensure that psychological interventions are high quality and evidence based Use high level research skills for evaluation, innovation, and to further develop the evidence base

Liverpool Psychology Service for Cancer - cont’d Support/Supervision/Training of others: Psychological interventions provided by staff at Level 3 Psychological support provided by staff at Level 2 Contribute to development of specific psychological skills in other staff such as breaking bad news, communication skills, working with bereaved relatives.

Liverpool Psychology Service for Cancer - cont’d We plan a phased process of introduction of the clinical service: To the Royal To other hospitals e.g. Heart & Chest, The Womens’ To Aintree Hospital – for Liverpool patients To Primary Care – Liverpool GPs In terms of direct & indirect work: Direct clinical service to patients Support to other staff providing psychological support Education & training to other staff re psychological approaches.

Liverpool Psychology Service for Cancer - cont’d Undertaking clinically relevant research, in collaboration with Division of Clinical Psychology, that leads to service improvement and innovation: Current research interests include: Communication Decision making Psychological distress: patients’ & health professionals’ perspectives Provision of high quality information re psychological care, coping and living with cancer.

Our vision for the service To develop, establish and provide a high quality specialist psycho-oncology service that is innovative, at the forefront of leading evidence based care for the people of Liverpool affected by cancer.