Cancer Research in Switzerland - Krebsliga Schweiz

Based on these qualitative results, a sample of 470 oncology
patients were surveyed using a written questionnaire.
In the survey, a behavioural model that had been developed
was tested. This model explains under what conditions
patients will become involved for their safety in hospital.
The results show that many patients are concerned
for their safety and errors in their care. A vast majority
agrees that they can contribute to the prevention of errors.
Patients themselves describe their capabilities as developing
in a learning process alongside the treatment
course, in which they acquire knowledge and skills concerning
what aspects of care to monitor, what to communicate
to care providers and how they can engage for their
safety. Patients acknowledge the benefit of error monitoring
and reporting but perceive the process of notifying
staff of potential errors often as unfamiliar and uncomfortable.
Behavioural control and subjective norms are the
key elements that explain whether patients communicate
their perceptions of safety problems. Oncology nurses
perceive involvement of patients as their core expertise.
They share a general positive attitude towards the approach,
even if communication about safety often is a
challenge for them. Nurses sensitively apply different
strategies to get patients involved through information
and motivation. However, they also see room for improvement,
particularly in the cultural implementation in hospitals:
“Patients need to experience from the beginning that
it is appreciated that they ask questions or notify us that
something is not correct”.
Based on these results, distinct recommendations can be
made to involve patients in the prevention of errors while
taking their individual situation into account. To be successful,
it is crucial that clinical staff informs, motivates
and supports patients.
Project coordinator
PD Dr. David Schwappach, MPH
Stiftung für Patientensicherheit
Asylstrasse 77
CH-8032 Zürich
Phone +41 (0)43 243 76 70
schwappach@patientensicherheit.ch
Stiefel Friedrich | Evaluation of individual psychotherapy
for emotionally distressed cancer patients:
A randomized controlled trial (OCS 01847-02-2006)
In order to evaluate the role psychotherapy can play in the
oncology setting, in the context of this study psychological
support was proposed to every new patient treated
between 2006 and 2009 by the Oncology Service of the
University Hospital Lausanne (CHUV).
Among the 2,000 patients approached, about half of
them had been excluded based on the criteria defined in
the study, mainly because of organizational reasons (living
too far away from the hospital, intensive treatments,
etc.), age > 75, advanced disease or language difficulties.
A quarter of the patients approached (n=530) refused to
participate in the study; of participating patients (n=419),
about half of them (n=190) wished to benefit from psychological
support, and the other half, who did not desire
psychological support, agreed to be regularly evaluated
with regard to their psychological state. Patients who de-
sired support received either 4 or 16 sessions of brief psychotherapy
and were regularly evaluated for a period of
a year with regard to their psychological symptoms and
quality of life, as this was the case for participating patients
who did not wish to have this support.
The results showed that for a lot of patients, it is difficult
to organize or to accept psychological support; about
20 % of patients included in the study, or 10 % of the total
population approached, desired psychological support;
patients motivated to receive support were in psychological
distress; two-thirds of participating patients
showed signs of important emotional detachment with regard
to the efficacy of psychotherapeutic support. Data
analysis is still ongoing.
We conclude 1) that in the oncology setting, psychological
support should be proposed proactively, for example
through different modes of communication (telephone,
e-mail), and more flexibly, for example by consultations at
a patient’s home; 2) that at least 10 % of patients wish to
benefit from psychological support at the beginning of
treatment; 3) that patients in psychological distress were
also those who desired support and that systematic
screening of patients in need of support, for example by
means of a questionnaire, may probably not be necessary;
and 4) that because of the emotional detachment of patients
with cancer, evaluation of the effects of psychotherapies
should use other methods than those utilized up
to now.
This study has produced important results that contribute
to the conceptualization and implementation of psychological
support in oncology centres and to adjusting scientific
investigation of this domain.
Project coordinator
Prof. Dr Friedrich Stiefel
Service de psychiatrie de liaison
Centre hospitalier universitaire vaudois (CHUV)
Bugnon 44
CH-1011 Lausanne
Phone +41 (0)21 314 10 90
Fax +41 (0)021 314 10 86
frederic.stiefel@chuv.ch
Stiefel Friedrich | Effects of communication skills
training on oncology clinicians’ communication styles
and defense mechanisms (KLS 02035-02-2007)
The importance of the quality of exchange between patient
and physician has been recognised for several decades.
Concerning the patient, it has been demonstrated
that efficient communication can influence treatment adherence
and improve quality of life and satisfaction with
regard to care. Concerning the physician, it is known that
efficient communication increases job satisfaction and
reduces stress and/or burnout.
Given the call for patient-centred medicine, all domains of
health care are invited to pay attention to communication
challenges. This is particularly true of oncology, which implies
breaking bad news and because of the social representations
of cancer.
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