Work in Progress

a) To develop and evaluate a model of skills training for cancer doctors, nurses and other staff to deliver SuPaC interventions.

We are bringing together the different initiatives examining ways of training of cancer health professionals to deliver psychological interventions which are currently being undertaken by members of COMPASS. These include:

• Training oncology nurses to deliver a multicomponent intervention for major depressive disorder. This work is being undertaken at Edinburgh led by Professor Michael Sharpe
• Training palliative care nurses to use deliver cognitive behaviour techniques to manage anxiety and depression in patients with advanced cancer. This work is being undertaken at King's College London led by Professor Matthew Hotopf and Professor Stirling Moorey
• Training oncologists in the use of quality of life data in their consultations with patients. This work is being undertaken at Leeds University led by Dr Galina Velikova
• Training diagnostic radiographers to deliver a psycho-educational intervention to promote early presentation of breast cancer among older women. This work is being undertaken at King's College London, led by Professor Amanda Ramirez and Dr Caroline Burgess

A successful scientific research session of the COMPASS Collaborative was held in September, 2007 to share the learning from these respective initiatives and suggestions for future collaborative work were considered. (click here to download a Summary Report on Compass Strand Three Scientifc Session: September 2007.)

b)To examine ways of improving the mental health of cancer doctors, nurses and other staff

Risk factors and prevalence of poor mental health across the cancer workforce

Poor mental health among health professionals is damaging for the professionals and their families, and also leads to poor patient care (eg Taylor et al, 2007). We are pursuing work to measure and improve the mental health of the cancer workforce. Previous work at KCL led by Professor Amanda Ramirez has shown that the mental health of cancer consultants has deteriorated since the mid 1990s. National surveys of UK hospital consultants from 5 specialties undertaken in 1994 and 2002 found that the proportion with psychiatric morbidity rose significantly from 27% in 1994 to 32% in 2002 (Ramirez et al, 1996; Taylor et al, 2005). This increase in prevalence of poor mental health varied by consultant specialty and was particularly marked in clinical and surgical oncologists, with a similar trend for medical oncologists. An increase in job stress without comparable increase in job satisfaction over the period between the two surveys accounted for the deterioration in mental health observed among the in the cancer specialists.

We now wish to extend this work by examining the prevalence of and risk factors for poor mental health in both doctors and nurses through a systematic review of the world literature. This review is being led by Liz Jamieson at KCL.

A follow-up national study designed to reassess the mental health, job stress and job satisfaction of cancer consultants after a period of 7 years is now planned as part of the core CR-UK research programme at KCL. Through COMPASS we will also assess the mental health, job stress and job satisfaction of other cancer health professionals who are members of the cancer multidisciplinary team, including clinical nurse specialists. We aim to investigate the impact of policies introduced to improve patient care such as the workforce capacity, multidisciplinary team-working and patients' complaints policies on the working lives of cancer health professionals. The involvement of nurses and allied health professionals will be co-led by Liz Jamieson in collaboration with Professor Alison Richardson.

Evaluating the impact of national skills training initiatives on job satisfaction

The impact of a team-based training programme on the working lives of colorectal cancer doctors has been undertaken as part of the core CR-UK research programme at KCL. This project has been broadened to include an evaluation of the working lives of other members of the cancer MDT. This broadening has been facilitated by collaboration with Professor Alison Richardson. The project involves a pre-test post-test questionnaire survey which was been undertaken to evaluate the impact of involvement in the Pelican Multi-disciplinary Team-Total Mesorectal Excision (MDT-TME) Development Programme on the job satisfaction and team functioning of colorectal MDT members. The results are currently being analysed.

A second component of this project aims to develop a measure for rating observed team functioning. This work is being led by Liz Jamieson and is based on observing multidisciplinary team meetings which have been videotaped. This has been adapted from a review of effective MDT working in breast cancer conducted in Australia (National Multi-disciplinary Care Team Project, 2003. National Breast Cancer Centre) (see full report Chapter 14)

Aspects of MDT working that are rated include leadership/chairing style; quality and completeness of meeting preparation; quality of IT equipment and resources; inclusiveness and respect within the team; quality of decision-making process in terms of evidence-base and patient-centredness; and procedures for recording and communicating decisions outside MDM. A manual for rating these aspects of team working is close to being finalised and inter-rater reliability of videotaped MDMs is due to start in November 2007 within the team followed by independent review by third party experts.

We propose to develop an approach to assessing the level of functioning of multidisciplinary teams based on:

• Our observational measure of the functioning of the multidisciplinary team meetings
• Team self report on functioning using The Aston Team Performance Inventory (ATPI, West et al, 2005)
• Nationally collected data on multidisciplinary team adherence to National Peer Review Measures (CQUINS scores).

We anticipate that one of the outcomes of this work will be the development of good practice guidelines for the conduct of multidisciplinary team meetings in cancer care.