Interventions for improving psychosocial care and support in routine oncology practice.

A cancer diagnosis may have a significant impact on an individual and those around them. This is not always recognised in routine oncology practice, and information provision for patients on psychosocial difficulties may be delivered in an ad-hoc manner. Unresolved social difficulties may undermine patients’ abilities to deal with the larger stressors of the disease and its treatment, increasing the burden on patients and services. The overall aim of the work presented in this thesis was to explore implementation of a programme of social difficulties assessment, which utilised the Social Difficulties Inventory (SDI-21) and included staff training and provision of information to patients. Pilot randomised controlled trials (RCTs) were conducted to explore the role of two components of this programme in managing social difficulties. The first was a study-specific information resource, which was developed, evaluated, and its impact on processes of care, patient behaviours and well-being assessed through the pilot RCT. Secondly, an assessment method, incorporating training for nurses in utilising the SDI-21, was evaluated in the second RCT. Both RCTs were used to calculate estimates of effect sizes to inform future trials of these interventions. The information resource was not widely used. Qualitative data suggested various reasons for this, including that patients are faced with an often overwhelming amount of information. Difficulties in implementing the assessment process were experienced in the second RCT, confounded by issues with recruitment. Qualitative data provided depth of understanding around implementation issues and highlighted key considerations for future trials. Small effect sizes were observed for both interventions. Development of a full RCT cannot be recommended based on the findings presented here, and alternative trial designs (e.g. quasi-experimental, service improvement models) should be considered.