Tenovus Cancer Care Counselling Evaluation. September 2016

Transcription

1 Tenovus Cancer Care Counselling Evaluation September

2 Contents Contents 1. Context Background General Findings Findings: Age Findings: Gender Findings: Client Type

3 1. Context Since the 1970s research has shown the positive impact of counselling for people with a cancer diagnosis (Simonton et al 1981; Spiegel et al 1989). Most recently a research team based at Oxford University found counselling for cancer patients with depression can improve depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all time points (Sharpe et al, 2014), the study concludes: that depression care for people with cancer is an effective treatment [and] offers a model for the treatment of depression comorbid with other medical conditions (ibid, 2014:1) More generally key findings from research on support after cancer diagnosis highlights issues around isolation following treatment, disparity between ethnicity and gender and survival (Taylor, 1986; Meyer & Mark, 1995; Moorey, Greer, Bliss & Law, 1998). Effects include the reformulation of cancer as an illness, managing situations, building courage to express one s own needs and insufficient support. The benefits of counselling for people with cancer have been shown in a Swedish study carried out between 1988 and 2000 (Ohlen et al, 2005) showing: 67% of the participants stated that they had received improved understanding of their own reactions and feelings. Nearly half the group (40%) experienced distance to their disease and life situation. Some participants also said that they experienced increased pleasure in life (44%), had more ability to take action (42%), and were less frightened (37%) after the intervention (Ohlen, 2005: 64) This study uses quantitative methods for evaluating the intervention. The data was collected through a specifically developed questionnaire asking for self-reported levels of change in generic terms. Despite the large sample size in this study it could be critiqued for using a non-validated data collection tool making the study incomparable with other studies of noncancer patients, for example. Few specific evaluations on psychosocial support or counselling services for cancer patients have been conducted and, while a number of papers have been published on the use of CORE-10 as a tool for measuring psychological distress, very little research is published specifically on its use in the field of cancer. This paper contributes to the identified lacunae in quantitative research on the impact of counselling for cancer patients and people affected by cancer. It also highlights the outcomes and subsequent value of using a validated screening tool for psychological distress in a study of 324 people affected by cancer who received counselling in Wales between April 2014 and All Tenovus Cancer Care counsellors use CORE-10 as a continuous measurement of counselling impact at assessment, first, middle and end sessions with a client. CORE-10 is a 10 item version of the CORE-OM and is a clinical screening tool developed in 1996 for audit, evaluation and outcome development (Barkham et al, 2006; 2013). CORE is a widely used measure in clinical practice. See Appendix 1 for a copy of CORE-10. (Source: Pearce Tenovus Counselling Evaluation: Analysis of CORE-10 forms April ) 3

4 2. Background Back to Top CORE-10 Items cover anxiety (2 items), depression (2 items), trauma (1 item), physical problems (1 item) functioning (3 items - day to day, close relationships, social relationships) and risk to self (1 item) (CORE-10 User Manual V 1.0, 2007). The measure has six high intensity/severity and four low intensity/severity items; broken down as follows Domain: Intensity Question cluster 1. I have felt tense, anxious or nervous Anxiety Low 2. I have felt I have someone to turn to for support when Low needed Close relation 3. I have felt able to cope when things go wrong General High 4. Talking to people has felt too much for me Social relations High 5. I have felt panic or terror Anxiety High 6. I have made plans to end my life Harm to self High 7. I have had difficulty getting to sleep or staying asleep Physical Low 8. I have felt despairing or hopeless Depression High 9. I have felt unhappy Depression Low 10. Unwanted images or memories have been distressing me Trauma High CORE-10 scores are normally divided into four categories as follow: Category Score 1 Healthy Moderate Moderate severe Severe CORE-10 is typically completed by Tenovus Cancer Care counselling clients in an initial telephone assessment then first, middle and end counselling sessions. The number of CORE-10 forms does not represent the number of sessions that counselling clients have received, but the most common number of sessions is six. Tenovus Cancer Care counsellors use a range of approaches but this has not been included in analysis because the small number of Tenovus Cancer Care counsellors would not allow a fair comparison between approaches. 4

5 3. General Findings Back to Top Effectiveness Tenovus Cancer Care counselling is effective: Effectiveness of Counselling The graph above shows the percentage of clients who were scored, healthy, moderate, moderate severe and severe scores at assessment, first, middle and end session. As last year, the graph shows an increase in healthy scores and a decrease in all other scores. Change in score between assessment and CORE-10 1 (typically taken at first counselling session) shows significantly less change suggesting that most improvements are made when counselling takes place and not before. This indicates that counselling is an effective intervention. Finally, none of the individual clients who completed four CORE-10 forms had worsened, while some who only completed two or three CORE-10 forms did worsen. This could make a case for ensuring clients receive a minimum of six counselling sessions. Average change in score 5

6 Tenovus Cancer Care counselling client numbers have increased significantly at assessment, CORE-10 1, CORE-10 2 and CORE-10 3 : Number of counselling clients per year The graph above shows that between 2014 and 2015, 324 counselling clients were assessed using CORE-10. This is 142 more assessments than in and 185 more than Despite this increase, drop of rates are still consistent between 2015/16 and 2014/15 with 73% going on to undertake a first session and 50% completing four CORE forms. 6

7 4. Findings: Age Back to Top Perhaps unsurprisingly given the nature of cancer, the breakdown of clients increases with age with the largest percentage being the 61-70% groups. In fact, the age groups make up 74.8% of the counselling population. Client numbers by age range In line with overall increases in client numbers, every age group saw an increase in numbers. For example, the groups saw more than twice as many clients than the previous year. The under 21 group however, continues to be poorly represented. Further research would be required to understand the causes for this but possible reasons may include proportionately smaller numbers being affected by cancer, alternative mechanisms of seeking support, and a lack of engagement or enthusiasm for traditional counselling or reduced exposure of Tenovus cancer care counselling amongst this community. 7

8 Average CORE score by age group Every age group saw a decrease in scores between assessment and final score. 1 In the majority of age groups, we can see an increase in score between assessment and first score, again suggesting that counselling has played a decisive role in improving scores. 1 The under 21 group, with only 2 clients, had no data past the first session so no trend can be analysed here. 8

9 The difference in scores varies from a change of 2 through to a change of Caution must be taken however as the change by 2 in the under 21 group is largely due to there being no data available after the first session CORE form. In addition, the and 81+ groups had significantly less participants (16 and 4 respectively) so any individual change in score will be exaggerated in the average. Age Assessment Final Avg. number of forms Change Score completed in score Under 13.5 N/A There appears to be little difference between age groups in terms of average number of completed forms suggesting, with the exception of under 21, completion of a course of counselling is not influenced by age. Change in average score by question between assessment and final CORE Score Change in Domain: Intensity Question score cluster 1. I have felt tense, anxious or nervous Anxiety Low 2. I have felt I have someone to turn to for Low support when needed Functioning 3. I have felt able to cope when things go High wrong Functioning 4. Talking to people has felt too much for me Functioning High 5. I have felt panic or terror Anxiety High 6. I have made plans to end my life 0.05 Risk to self High 7. I have had difficulty getting to sleep or Low staying asleep Physical 8. I have felt despairing or hopeless Depression High 9. I have felt unhappy Depression Low 10. Unwanted images or memories have been distressing me Trauma High 9

10 Change in average score by question between assessment and final CORE Score Counselling appears to be particularly effective in decreasing scores which have a low intensity. Some caution must be taken here, however. Question 5 and 6, which are categorised high intensity, already have low scores in comparison to other questions. Therefore it has little room to reduce any further. This is known as the floor effect. 10

11 5. Findings: Gender Back to Top 73.1% of counselling clients were female with 23.2% male and no data being available for 3.7%. Last year, this figure was 74% male and 26% suggesting, whilst consistent, there has been little change in the gender breakdown Clinical score by gender % Males Females Assessment Score First Score During Score Final Score This year, there seems to be little difference between males and females in terms of both score at assessment and final score. Interestingly, it seems that female scores worsened between assessment and first score whilst the male score made a small improvement (in reality it remained constant). Amongst both genders, scores improved considerably with the commencement of counselling. 11

12 Change in Clinical score by gender % The graph above shows the pattern of change in score by gender. As the previous graph showed, males and females start and finish counselling with similar scores. The difference comes in the pattern between these scores. We can see from the graph above that for males, the score between assessment and first improves very slightly (0.3) before this improvement accelerating as counselling progresses. For females, the score actually worsens (0.8) between assessment and first scores. This difference in score is then largely realigned in the change in score between first and during when females improve by 1% more than males. 12

13 Average score by question and gender at assessment There was a variation between genders in terms of which particular issues scored the highest at assessment. For females these are question 1, 3 and 9 whilst for males these are questions 2, 7 and 10. This differs from last year where the same issues for of concern for both genders. Change in average score by question and gender between assessment and final CORE Score 13

14 Counselling appears to be most effective at dealing with the low intensity issues. These are the questions which have produced the largest decrease in CORE score. Amongst men, question 5, 6 and 10 appeared to show little difference in average score this year. Again, caution must be taken here as little change may well be the effect of the floor effect more than anything else. Client breakdown As the chart above shows, the majority of clients came from Cardiff and Vale (28.7%) and Hywel Dda (25.5%). Therefore, these health boards amount to 54.2% of clients. There were no clients from Powys teaching health board. 14

15 6. Findings: Client Type Client type No % Bereaved Carer Incomplete Patient Total % of clients were patients with an additional 14% recognising themselves as carers. 11.2% were bereaved with the remaining 5.4% with an unknown classification. These figures are fairly similar to last year which was 71.4%, 14.8% and 9.9% respectively. Client type No % Patient Non-patient Unknown Total

16 % of client type completing each core form If we combine all non-patients as one, we can see that there is little difference between patients and non-patients in terms of numbers assessed. By first session, 64.8% of nonpatients went on to undertake a CORE form whilst only 59.1% of patients did so. After this, a greater proportion of patients to non-patients continued to undertake counselling with a 4.2% difference at the during stage. By the final score however, this difference is reduced to a 1.4% difference in favour of patients. Average score per CORE form by client type % 16

17 Interestingly, the chart above shows that carers begin and end counselling with consistently poorer scores than patients. This only serves to highlight the importance of the availability for non-patients. In both groups, the score worsens between assessment and first score before counselling begins and scores improve. The difference between the two groups is 1.4 at assessment and 2.2 by last session. Therefore, both groups improve with patients only improving by 0.8 more than non-patients over the sessions. Cancer type The graph above only serves to highlight the large range of cancers that those who attend counselling may be diagnosed with. Despite this, breast cancer still makes up 43% of all diagnoses. This may be due to a range of factors including females being the most likely to attend counselling, the higher incidence rates of breast cancer and the predicted survival rates of breast cancer. 17