The psychosocial needs of rural cancer patients.

Abstract

Psychosocial interventions are increasingly recommended as a standard part of care for cancer patients due to their proven utility and this patient groups’ elevated risk of psychological distress. However, providing the third of Australian cancer patients who live in rural areas with psychosocial care is challenging. Little is known about rural cancer patients’ level of psychosocial service use or how suitable existing rurally-based services are to deal with cancer. Therefore, Study 1 identified key issues with the provision of psychosocial care from the perspective of rural South Australian cancer patients and explored ways these issues could be addressed. A thematic analysis of data from 17 semi-structured interviews revealed that, contrary to previous research, rural South Australian cancer patients do not consider lay support as an adequate substitute for professional services. However, a lack of relevant information, beliefs that such services are unnecessary and concerns about stigma and dual relationships hindered access to professional help. The study concluded that providing rurally relevant information on psychosocial services may improve knowledge about their availability and help to address rural cancer patients’ attitudinal barriers to service use. In light of the barriers identified in Study 1, the objectives of Study 2 were to develop a website that provided rural-specific information on psychosocial care for those affected by cancer in rural South Australia, (by engaging people with relevant life experience and reviewing the psychological literature), and to document the lessons learnt during this process. A Participatory Action Research (PAR) framework guided the website’s development. To motivate users to access psychosocial care, behaviour change techniques were also incorporated. The resulting 84-page interactive website, entitled Country Cancer Support, garnered widespread interest and use. It includes practical written information, low-intensity Cognitive Behaviour Therapy (CBT) self-help material, videos and a distress screening tool that provides tailored feedback and is linked to a support services directory. This method resulted in collaboration between several stakeholders, increased awareness of the value of rural-specific information and participants also reported a sense of empowerment associated with being involved. This study demonstrates the utility of PAR in addressing the psychosocial information needs of rural cancer patients and may inform the development other online, consumer-driven health promotion interventions. In Study 3, how acceptable this website is to its users was evaluated using an online survey and Google Analytics. There were 3957 visits to the website in the first 5 months. It was evaluated as easy to use, helpful and relevant, written by people who understood what they were going through and self-report measures suggested it was associated with increased motivation to access professional psychosocial support services and/ or travel for medical treatment (if relevant). Of relevant patients and supporters, 73% said using the website made them less isolated and 54% felt less distressed. The results reiterate the importance of interventions being targeted, creative and flexible, attitudinal barriers being addressed and the value of consumer involvement, particularly when developing interventions for populations whose unique needs are often overlooked and/or can easily be misunderstood. These findings have implications for isolated rural cancer patients in many parts of the world.