Abstract

Most cancer patients spend the last year of life at home, and are managed by generalist primary care services. District Nurses (DNs) provide support visits over many months before physical care is needed at the end of life. The purpose is to monitor and advise patients, and to provide psychological support, a recognised and potentially invaluable role for DNs. However from the literature and our research we know that many cancer patients have unmet psychological needs and DNs find psychological support difficult. DNs are often reluctant to ask about patients’ emotional needs and concerns because they lack confidence in dealing with them, and are apprehensive about time constraints. DNs are therefore not used to their full potential in providing psychological support for patients and often lack training in this respect.
Connolly et al have developed a communication skills tool that addresses health care professionals’ concerns about confidence and time constraints when managing the psychological needs of cancer patients. The tool uses the mnemonic SAGE & THYME to guide nurses through person centred assessment (SAGE), and simple problem solving (THYME). It mobilises the patient’s existing coping strategies and resources. The mnemonic helps the practitioner to stay focused, which both saves time and also helps to identify when s/he has insufficient skills and needs to access specialist support. SAGE & THYME has a strong theoretical foundation in Rogerian humanisitic psychology and self efficacy theory and a research base in effective communication and person centred problem solving.  SAGE & THYME has not however been systematically evaluated with DNs, who interact with patients in their own environment with carers often present, nor has its impact on patients been assessed. This study is a pilot implementation of SAGE & THYME communication skills tool by 30 DNs with cancer patients in the home care setting. The DNs will be interviewed in 3 focus groups of 10 on three occasions: pre-training in SAGE & THYME, immediately post-training and two months post-training to discuss perceptions of the tool’s utility, acceptability and feasibility before and after its use in practice.