Rationale

Psycho-oncology research is still in its infancy compared to other areas of psychological research. There remain many unanswered questions regarding the psychological impact of cancer on patients and their families, and more so, the ability of psychological interventions to reduce this impact. Given the increasing numbers of those affected by cancer worldwide, it is crucial that attempts are made to answer many of these questions. The current study hopes to make a valuable contribution, not only to the current psycho-oncology literature as a whole, but also more specifically to cancer-related research within New Zealand. Specific rationales for the current study are outlined below.

A large proportion of the psycho-oncology literature to date has focused on the impact of cancer on the patient. However, research examining the impact of cancer on family members is relatively sparse. Research that has been conducted has revealed that the diagnosis and treatment of cancer has just as much impact on the family as it does on the cancer patient (Compas et al., 1999; Northouse & Stetz, 1989). Like patients, families can differ in their ability to cope with the impact of a cancer diagnosis (Cassileth et al., 1985). Therefore, this study will provide further valuable information regarding the impact of cancer on family members/whanau.

Researchers have repeatedly stressed the need for rigorous, evidence-based evaluations of psychotherapeutic interventions. Randomised controlled trials (RCT) are generally considered to be the most thorough methodology for evaluating an intervention’s effectiveness. However, many researchers believe RCTs to be the wrong methodology for empirically validating psychotherapy as it is practiced in the field (e.g., Fensterheim & Raw, 1996; Persons & Silbershatz, 1998; Seligman, 1995). It is argued that RCTs lack ecological validity (Howard et al., 1996) and do not focus on the types of clients seen, or

therapies used in practice (Parloff, 1979; Persons, 1991). Conducting quasi- experimental studies, however, enables the assessment of how therapy works in practice (Howard et al., 1996). This study will gather valuable information regarding the effectiveness of psycho-oncology interventions as they are conducted in clinical practice.

The debate about the efficacy of psychotherapeutic interventions in alleviating psychological distress in people with cancer continues (Coyne, Lepore & Palmer, 2006). One of the main contributory factors for this is that researchers have not yet been able to consistently identify the key factors responsible for the positive outcomes observed following treatment. It is argued that to understand the relationship between treatment and outcome, it is crucial to examine factors which can influence outcome (Shadish & Sweeney, 1991). This study will attempt to address this issue by examining the factors influencing the effectiveness of the interventions provided by a psycho- oncology service. Although the majority of research in this area has predominantly been quantitative, many researchers (e.g., Howe, 1993; McLeod, 1990) have highlighted that obtaining clients’ perceptions of their psychotherapy experience is an important way of gathering this information. Therefore, this study will seek to obtain valuable qualitative information with regard to the interventions provided by a psycho-oncology service.

In 2003, the New Zealand Cancer Control Strategy (Ministry of Health, 2003) recognised that psychosocial support was a crucial element in delivering quality cancer care to patients and their families. In 2006, Surgenor, Costello and McKellow conducted a national stocktake of psychosocial cancer services in New Zealand for the Ministry of Health. They found that while there was wide provision of general emotional, cultural and complementary support services, there was a lack of specialist psychological and mental health support. The need for supportive care for people with cancer has more recently been acknowledged, with the Ministry putting forth “Guidance for Improving Supportive Care of Adults with Cancer in New Zealand” (Ministry of Health, 2010). However, despite this growing recognition of the importance of psychosocial support in New Zealand, the majority of research examining the

effectiveness of psychotherapy in alleviating psychological distress in people with cancer has been internationally based. To the author’s knowledge, only one study examining cancer patients’ needs and experiences of supportive health care services in New Zealand has been published (Walton, Reeve, Brown & Farquhar, 2010). Therefore, in keeping with the goals of the New Zealand Cancer Control Strategy and the more recent clinical guidelines, this research will provide much needed New Zealand evidence-based research regarding improving quality of life for those with cancer, their family and whanau.

In 2006, with funding from the MidCentral District Health Board, the Massey University School of Psychology began delivery of New Zealand’s first integrated psycho-oncology service. The psycho-oncology service is a specialised psychological intervention service for people with cancer and their family/whanau experiencing significant distress. The service works in conjunction with other psycho-social services (e.g., social workers, specialist and oncology nurses, chaplains, the New Zealand Cancer Society, and the Child Cancer Foundation). Clients living in the MidCentral DHB catchment are referred to the psycho-oncology service from the Regional Cancer Treatment Service. However, cancer patients and their families from other DHBs which are serviced by the RCTS are able to access the psycho-oncology service if they have been referred to Palmerston North for medical treatment (e.g., radiation therapy). Clients can receive individual, group and/or family sessions that can be accessed from a variety of locations, including the university psychology clinic, local hospital, and in the community. The service receives clinical contributions from four qualified and registered clinical psychologists drawn from a pool of psychologists at the university psychology clinic, two of whom are solely contracted to the service. The aims of the service are to improve clients’ quality of life by reducing distress, assisting with coping strategies, improving adjustment, and promoting active choice and participation in treatment. Intervention strategies implemented by therapists include Cognitive Behavioural Therapy (CBT), supportive and expressive therapies, behavioural techniques (e.g., relaxation), training in problem-solving,

assertiveness, and coping. Some demographic information regarding service use is outlined in Table 1.

Table 1: Psycho-Oncology Service Demographics (2006-2010)

Ethnicity Gender Client

NZ European NZ Maori Non NZ European Pacific Islander

Male Female Patient Family Member

81% 12% 5% 2% 37% 63% 72% 28%

While this service is based on international research and guidelines, much of this has not been tested with the New Zealand population. As a result, the present research study will examine the effectiveness of the interventions provided by the service; and to investigate whether the psycho-oncology service achieves its aim of improving quality of life for those affected by cancer in New Zealand. The results of this study will also provide information that can be used by other DHBs in the implementation of similar services throughout the country.