The development of a psychological prehabilitation intervention for sarcoma patients: a feasibility study

Caines, Victoria (2019). The development of a psychological prehabilitation intervention for sarcoma patients: a feasibility study. University of Birmingham. Clin.Psy.D.

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Abstract

Introduction: Sarcoma is a rare form of cancer that is often misdiagnosed or diagnosed at an advanced stage. Surgery is the recommended first line treatment. Patients diagnosed with sarcoma report anxiety before surgery and a percentage of this patient population are at risk of psychological distress following surgery. The practice of prehabilitation has a growing evidence base for improving surgical outcomes for a range of cancers; however, it is yet to be demonstrated if prehabilitation for Sarcoma is feasible and offers benefit to sarcoma patients. The present study looks to investigate the feasibility of trialling a randomised control trial of psychological prehabilitation for Sarcoma patients.

Method: A controlled pre - post study was designed, following a request from the sarcoma health care team at the local trust, reporting a need for care before surgery. Furthermore, previous research conducted by Tsimopoulou (2015) and Asfaw (2019), identified the need and benefits of prehabilitation in sarcoma patients. A one-hour intervention was created and offered to sarcoma patients, recruited to the study. Participants were randomised to either a control or experimental arm. Participants were asked to complete six questionnaires regarding their emotional and physical wellbeing. Following this, participants in the experimental arm received a psychological intervention with a trainee clinical psychologist prior to their surgery. The intervention was informed by Acceptance and Commitment Therapy and Compassion Focused Therapy. All participants then underwent surgery. Outcome measures were repeated at approximately four weeks after surgery. In addition to the formal outcome measures, the feasibility of the study was assessed in regard to the feasibility of recruitment, follow-up and randomisation, amongst other parameters.

Results: Nine participants took part in the feasibility study. It was feasible and acceptable to randomise participants between conditions; however, participants completed follow up measures within differing timescales. A Cohen’s D power calculation identified that for a randomised control trial to have sufficient power, one hundred and sixteen participants would need to be recruited. Finally, reliable change calculations highlighted the appropriateness of the chosen measures as they were found to be sensitive to changes in this population.

Discussion: The study indicated that it would be feasible to implement the psychological intervention as part of a randomised control trial of prehabilitation for sarcoma patients, with a number of modifications to the present design. Modifications include embedding the study within the service to utilise existing resources in order to increase both recruitment the controllability of the study. Furthermore, prehabilitation may only be indicated for a percentage of patients with Sarcoma therefore a pathway approach, where individuals are screened for vulnerabilities to psychological decline following surgery are identified, with other patients receiving treatment as usual.

Type of Work:

Thesis (Doctorates > Clin.Psy.D.)

Award Type:

Doctorates > Clin.Psy.D.

Supervisor(s):