Improving Psychological Support by District Nurses in Palliative Home Care:
A Pilot Study of a Communication Skills Tool
Griffiths, J (1) Wilson, C (1) Ewing, G (2) Connolly, M (3) Grande, G (1)
1 University of Manchester, School of Nursing, Midwifery & Social Work, Oxford Rd M13 9PL, UK; 2 University of Cambridge, Centre for Family Research, University of Cambridge, CB2 3RF, UK; 3
University Hospital South Manchester, Wythenshawe, Manchester, M23, 9LT, UK
Background
Findings
In the UK, most cancer patients spend their last year of life at
home, supported by District Nurses (DNs). A component of DNs’
work is psychological support1. However, research shows that
many cancer patients have unmet psychological needs and DNs
find psychological support difficult 2,3. Connolly et al4 have
developed an evidence based 5- 8communication skills tool
taught in a 3 hour workshop that addresses concerns about
managing the psychological needs of cancer patients. The tool
uses the mnemonic SAGE & THYME to guide practitioners
through patient centred assessment and simple problem
solving.
Pre-training focus groups
Aim
To train DNs in SAGE & THYME and explore its utility with
cancer patients in the home care setting.
Method
DNs were interviewed in 4 focus groups of 4-10 participants on
3 occasions: pre-training, immediately post-training and two
months post-training to discuss perceptions of the utility of
SAGE & THYME before and after its use in practice.
SAGE & THYME
Setting: If you notice concern - create some privacy – sit down
Ask: “Can I ask what you are concerned about?”
Gather: Gather all of the concerns – not just the first few
Empathy: Respond sensitively – “You have a lot on your mind”
Talk: “Who do you have to talk to or to help you?”
Help: “How do they help?”
You: “What do YOU think would help?”
Me: “Is there something you would like ME to do?”
End: Summarise & Close ‘Can we leave it there’?
There was a strong interest in basic communication skills
training to build on existing experience
‘We’ve had no communication skills training’
‘How do you know there’s not a better way of doing things if
you’ve never been trained?’
Immediately post-training focus groups
DNs were very positive about the tool and confident about
using it in practice
‘It gives you a structure..and leads you through the questions
you need to ask and find out...it gives you a closing as well’
‘We need to listen, give more time, not jump in’
Two month post-training focus groups
All DNs had applied SAGE & THYME in practice. Some followed
the mnenonic closely, others used it to facilitate recall of
general principles of patient-centredness
‘It’s a bit like self-help really,... encouraging the patient to
sort of...reflect on..resolve their own problems’
’You’re not fobbing them off, you’re empowering them in a
different way, and they do look quite positive when you leave’
‘The question where you say..who have you got to help
you..that was brilliant..that brought a lot more information’
Conclusion
Data Analysis
Perceived benefits of SAGE and THYME
Thematic content analysis facilitated by Nvivo software.
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Facilitates opening and closing of conversations and offers
structure for consultations
Aids recall of patient-centred communication
Encourages DNs to hold back with giving advice
Allows patients to find own solutions
Improves DNs’ confidence in their communication skills
Implications
 Training in SAGE & THYME in a 3 hour workshop appears to
be an efficient and cost-effective way to improve
communication skills of DNs working with cancer patients
Future research is needed to assess how DNs use the tool in
practice and to determine any benefits of the tool for patients
References
1 National Institute for Clinical Excellence (2004) Supportive and Palliative Care Guidance NICE, London.2. Griffiths J, Ewing G, Rogers M (2010) Moving swiftly on: Psychological support provided by District Nurses to patients with
palliative care needs Cancer Nursing 33 (5) 390-397. 3. Griffiths J, Ewing G, Rogers M, Barclay S, Martin A, McCabe J, Todd C (2007) Supporting Cancer Patients With Palliative Care Needs: District Nurses' Role Perceptions Cancer
Nursing 30 (2) 156-162. 4. Connolly M, Perryman J, McKenna Y, Orford J, Thomson L, Shuttleworth J, Cocksedge S (2010) SAGE & THYME: a model for training health and social care professionals in patient-focussed support. Patient
Education and Counselling 79(1) 87-93. 5. Rogers C (2003) Client centred therapy: its current practice, implications and theory Constable, London. 6. Bandura A (1982) Self-efficacy theory in human agency American Psychologist 37(2)
122-147. 7. Maguire P, Faulkner A, Booth K, Elliott C, Hillier V (1996) Helping cancer patients to disclose their concerns European Journal of Cancer 32a 78-81. 8. McCormack B, McCance T (2006) Development of a framework for
person-centred nursing Journal of Advanced Nursing 56(5) 472-479