Clinical judgment of the need for professional mental health care in patients with cancer: a qualitative study among oncologists and nurses

The role of mental health nursing in pediatric hematology/oncology - Part 3: Evaluating feasibility, acceptability, and appreciation

Introduction

In February 2022, we introduced the innovative new role of mental health nurse clinician (MHNC) in pediatric hematology/ oncology in a pediatric hospital in Quebec with the aim of better addressing the needs of young cancer patients and their families. In two previous articles, we explained the method used to develop the role, as well as the strategy employed to implement it.

Objectives

In this article, we seek to evaluate the effectiveness of the implementation strategy by measuring role feasibility. We will also examine role acceptability and appreciation 1 year following implementation.

Methodology

We asked three groups of participants (adolescents, parents and care providers) to complete a research questionnaire based on the Theoretical Framework of Acceptability (TFA), with good inter-rater reliability and discriminant validity. The questionnaire, which was made available online, consisted of statements with Likert-scale responses (from 1 to 5), as well as open questions. We performed a standard descriptive analysis and used the responses to the open questions to support or add nuance to the quantitative results.

Results

In total, 31 healthcare professionals, 10 adolescent cancer patients and 10 parents of adolescent cancer patients filled out the questionnaire. Between February 2022 and February 2023, the MHNC provided a total of 691 interventions to 112 individuals (patients and parents). Follow-up sessions were offered to 61 individuals, and 99.6% of them accepted. We found a very strong correlation (r = 0.96) between the number of hours worked by the MHNC and the number of interventions provided. The vast majority of participants from all three groups agreed that the role is appropriate, appreciated and necessary, and that it brings much-needed clinical expertise in mental health to the department. Care providers, adolescents, and parents indicated that they would request this service again and would recommend it to others, if it were needed. The results, therefore, demonstrate excellent feasibility and high levels of acceptability and appreciation.

Conclusion

Our study shows that the implemented MHNC role helps improve the clinical management of the mental health of adolescents with cancer, as well as their parents. The role brings much-needed expertise in psychiatric nursing care and supports the clinical practice of care providers. Another study will be conducted in the near future to measure the effectiveness of the MHNC's interventions.

The role of the mental health nurse in pediatric hematology-oncology - Part 1: Developing an innovative practice

Introduction

Pediatric hematological and oncological illnesses present many coping challenges. Mental health issues can arise during and after treatment, in both patients and their families. The current model of care does not always seem to meet the needs identified by some young patients. In Quebec, nurses are allowed to assess and care for patients experiencing physical and mental health difficulties (Ordre des infirmières et infirmiers du Québec, 2016). Therefore, a mental health nurse clinician (MHNC) with experience in pediatric hematology/oncology could provide care that is complementary to that offered by psychologists, social workers, and other psychosocial professionals in the pediatric hematology/oncology unit in order to meet any needs that remain unmet. The MHNC project has three stages: (1) role development, (2) role implementation, and (3) role assessment one year after implementation. In this first article, we explain how the MHNC role was developed.

Methodology

We used the participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA Framework; Bryant-Lukosius & Dicenso, 2004) to develop this model. The first five steps in the PEPPA Framework were applied in the creation of the MHNC role to (1) select the target population, (2) identify the stakeholders to be involved, (3) ascertain needs, (4) determine and prioritize problems and set goals, and (5) define a new model of care.

Results

After multiple meetings involving numerous health professionals and managers, the MHNC role was developed with a versatile, transdisciplinary perspective to address better the needs of young cancer patients (especially those in their teens) and their families. The role was developed around four main areas of practice: (1) interventions offered to patient-family, (2) interventions offered to health professionals, (3) psychiatric consultation-liaison, and (4) education and research.

Conclusion

The next steps are to use a strategic plan to implement the role and then to evaluate the impact of the role one year after implementation.

Toward an improved conceptualization of emotions in patients with cancer

Cancer and its associated treatment is a major stressor, leading to emotions such as anxiety or depressive mood. Human emotions have developed through the course of evolution because they facilitate adaptation to important events, such as cancer and its associated treatment. On the other hand, emotions can be maladaptive and interfere with adaptation to cancer. Emotions are maladaptive if they are disproportionally severe or persistent, and if they interfere with functioning. We aim to expand the conceptualization of adaptive and maladaptive emotions in patients with cancer. We draw on major theories in the field of mental disorder and mental health, and apply these theories to conceptualize adaptive and maladaptive emotions in patients with cancer. (i) Maladaptive emotions have two essential features: mental dysfunction and patient harm. Maladaptive emotions are characterized by a network of strongly associated emotional symptoms, which may include cancer-related somatic symptoms. The dysfunctional symptom network is hypothesized to be the result of disturbance of life goal pursuit caused by cancer. (ii) Adaptive emotions have two essential features: ability to deal with cancer and functioning well. The ability to use emotions in an adaptive way depends on skills to recognize, express, and regulate emotions in a flexible manner. A secure attachment style facilitates adaptive emotional responses to cancer. The present conceptualization of adaptive and maladaptive emotions is expected to contribute to better understanding and management of emotions in patients with cancer.

Psychologically informed health care

The term "psychologically informed health care" refers to the comprehensive integration of psychological principles into health care. Psychologically informed health care has the potential to lead to a transformation of care, resulting in truly transdisciplinary care. To facilitate its future development, we discuss key characteristics of this approach. These include the direct mode (psychologists assessing and treating patients themselves) and indirect mode (psychologists working through other health care providers) of integrating psychological principles into healthcare; the range of health domains targeted using this approach; transdisciplinary care, transcending traditional disciplinary boundaries; and the positioning of care. We describe a framework for transdisciplinary care, which we refer to as the Framework for Catalytic Collaboration. This framework comprises six dimensions: setting, disciplines, patients/clients, mode of psychological care, primary components of care, and primary targets of care. We also provide four brief illustrations of psychologically informed health care. Finally, we discuss future directions, including the need for professional recognition of the indirect mode, financing of the indirect mode, cross-disciplinary training and trans-disciplinary research.