1. Liverpool Psychology Service for Cancer
Dr Janice Ablett
Consultant Clinical Psychologist Professional Lead

2. The new service is funded by Liverpool PCT in partnership with RLBUHT and the Division of Clinical Psychology at the University of Liverpool, in collaboration with Aintree Hospitals Trust (for Liverpool patients).
It builds on existing service provision:
Clinical Psychology Fellow in Breast Unit
Health Psychology Fellow in nationally funded Ocular Oncology Service.

3. Prevalence of Psychological Need
Surveys indicate that one third to one half of cancer patients experience psychological disorders, with 20-25% reaching ‘caseness’ for depression. In palliative care these figures are higher.
British Psychological Society (BPS): 15-30% of patients are sufficiently distressed to require professional help at some point during their cancer trajectory.
Psychological morbidity in carers – significant numbers of carers experience psychological distress, in turn affecting their ability to cope & provide support.
Clinical staff themselves are at risk of psychological morbidity & burnout.

4. From diagnosis onwards
People experience a range of emotions; shock, fear, anger, sadness , guilt
No two patients with cancer show exactly the same emotional response, even if the physical status is very similar. Response depends on the individual perception of the threat of cancer, which is determined by the characteristics of the person concerned. (Holland, 1989).
Cancer is a disease shot through with uncertainty, and it is this uncertainty that makes everything so difficult. (Burton & Watson).

5. Psychological Needs in Cancer
People with cancer are at high risk of experiencing psychological difficulties such as:
Anxiety
Trauma related problem
Adjustment disorders
Body image problems
Depression
ANV
Interpersonal difficulties
Complex pain
Insomnia
Sexual dysfunction

6. Psychological needs in cancer
Consider referral for those who are:
Struggling to adjust over time
With intense emotional reactions that compromise their mechanisms for coping and self care
Who are ‘stuck’ in a way likely to impair future adjustment
With emotional difficulties that are unlikely to resolve over a reasonable time
Who need specialist psychological support when involved in complex decision making about treatment

7. Strategic Context & Drivers
The National Cancer Plan (2000)
Improving Outcomes Guidance ( )
NICE Guidance on Improving Supportive & Palliative Care for Adults with Cancer (2004)
MCCN Review of Psychological Services (2007)
The National Cancer Peer Review Programme ( )
Cancer Reform Strategy; achieving local implementation (2009)
National Cancer Survivorship Initiative (NCSI) vision (2010)

8. The local picture Liverpool is the Cancer Capital of Europe
with a mortality rate of 237 deaths per
100,000 and the highest level of cancer
incidence in England.
Liverpool Primary Care Trust has been identified
by the National Health Inequalities Programme as
being one of 13 PCTs in England that contribute
the greatest number of deaths by cancer.  
Liverpool Primary Care Trust, Nov 2009.

9. New Service PCT funded posts: Dr Jan Ablett
Consultant Clinical Psychologist/Professional Lead
Dr Helen Beesley
Principal Clinical Psychologist
Senior Clinical Psychologist
appointed
Dr Joanna Omylinska-Thurston
Counselling Psychologist
Mrs Susan Clark
PA/Secretary
University posts:
Dr Louise Clark
Clinical Psychology Fellow, Breast Unit
Ms Laura Hope-Stone
Trainee Health Psychology Fellow, Ocular Oncology
Mrs Helen Ullmer
Assistant Psychologist, Breast Unit
MCCN:
Mr Rob Dinwoodie
Assistant Clinical Psychologist; Information/leaflet study

10. A psychological service focussed on:
Alleviating psychological distress
Improving well-being
Person-centred care
Respect & dignity
Needs assessment (rather that distress management)
Prevention (& identifying vulnerabilities)
Improving quality of life
Cost effectiveness

11. Liverpool Psychology Service for Cancer: Level 4 – NICE guidance
Provide specialist psychological care for patients with severe distress and complex needs
Draw on a multi-theoretical base to inform assessments & interventions that are specifically tailored to individual need
Ensure that psychological interventions are high quality and evidence based
Use high level research skills for evaluation, innovation, and to further develop the evidence base

12. Liverpool Psychology Service for Cancer - cont’d
Support/Supervision/Training of others:
Psychological interventions provided by staff at Level 3
Psychological support provided by staff at Level 2
Contribute to development of specific psychological skills in other staff such as breaking bad news, communication skills, working with bereaved relatives.

13. Liverpool Psychology Service for Cancer - cont’d
We plan a phased process of introduction of the clinical service:
To the Royal
To other hospitals e.g. Heart & Chest, The Womens’
To Aintree Hospital – for Liverpool patients
To Primary Care – Liverpool GPs
In terms of direct & indirect work:
Direct clinical service to patients
Support to other staff providing psychological support
Education & training to other staff re psychological approaches.

14. Liverpool Psychology Service for Cancer - cont’d
Undertaking clinically relevant research, in collaboration with Division of Clinical Psychology, that leads to service improvement and innovation:
Current research interests include:
Communication
Decision making
Psychological distress: patients’ & health professionals’ perspectives
Provision of high quality information re psychological care, coping and living with cancer.

15. Our vision for the service
To develop, establish and provide a high quality specialist psycho-oncology service that is innovative, at the forefront of leading evidence based care for the people of Liverpool affected by cancer.