Josie Cameron, Breast Advanced Practitioner, Edinburgh Cancer Centre

Professor Humphris, Clinical Psychologist, University of St Andrews

Mara van Beusekom, Health Communication Scientist, University of St Andrews
DISCLOSURE
 Forecast Pilot supported by Breast Cancer Now grant

 Forecast 2 supported by Scottish Government Chief Scientists Office and

Breast Cancer Now grant
Forecast Pilot Study
 Unique study investigating FCR during treatment
 Recruited 100 pts
 All review consultations audio taped
 Questionnaires, daily FCR log and FU phone call
 Two, three, four field techniques incl DCIS
 2 – 3 consultations taped
 Scored using a psychology tool
Results
 FCR was less with older women compared with younger women
 Chemotherapy and Herceptin use was associated with increased FCR
 Patients with boost reported higher FCR than no boost or DCIS pts
 2/3 women experienced a decline in fear during and after RT.
 Addressing FCR at review clinics may be crucial in reducing the
development of it post treatment
Fear of Cancer Recurrence
 Forecast Pilot demonstrated that 1/3 of patients’ recurrence fears increase
during RT
 Weekly review clinics help patients manage these concerns
 By providing space for emotional talk and information to normalise how
the patient is feeling
 Communication style can positively impact on psychological wellbeing
 By preventing later clinical psychological problems and excessive FCR
Team
Forecast 2
Forecast 2 First Phase
 Patient representatives and therapeutic radiographers participate in
interviews
 Joint experience-based co-design session to identify ways to improve
communication during the radiotherapy review
Forecast 2 Second Phase
 Members of the Society of Radiographers and national patient
representation groups are consulted to develop a storyboard for the
production of the communication training package
Forecast 2 Experience –Based Co-Design
 Encourage an exchange of experiences
 To identify shared points for service improvement
 Creation of storyboards
 KEW Theory, trigger videos
 Training workshop with role play and goal setting for personal
development
 Consolidation workshop and self reflection
 Evaluation and feedback
KEW Model Prototype– Know Encourage Warmth
©2019 Humphris, van Beusekom
KNOW ©2019 Humphris, van Beusekom
Confidence
Show familiarity with person’s medical history by
commenting on prior visit or problem

Person
Personalise your approach to focus on what is
important to the individual

Expectations
Help patient understand what to expect at each
stage by checking their understanding
ENCOURAGE ©2019 Humphris, van Beusekom
Emotions
Encourage expressions of concern by asking open
ended questions

Space
Provide space for patient to elaborate by inviting
them to expand on what they have said

Follow-up
Ensure patient knows how they can continue the
conversation eg by making another appt or
reminding them of other contacts
Warmth ©2019 Humphris, van Beusekom
Start
Professional and supportive manner adopted at the
start

Normalise
Reassure the patient that their feelings are normal

Ending
End on a positive note, matched with non verbal
posture, gestures/smile
The ‘peak’ and end of the conversation will most
shape the patient’s experience
Trigger Videos
Difficult conversations with patients
▪ Fear of cancer recurrence concerns
▪ Patients who don’t want to talk about themselves
▪ Patients with challenging behaviour
▪ Good conversations – managing patient expectations and concerns
▪ Good conversations - ending a session
Forecast 2 Third Phase
 The acceptability and feasibility of the training is evaluated through
observations, recruitment rates and follow-up discussions
 Potential benefits are observed, with patients’ fear of cancer recurrence
(FCR7) as the primary outcome.
Forecast 2 Secondary Outcomes
 Short daily measure of recurrence, patients’ positive and negative affect
(PANAS)
 Perceived empathy from the radiographer (CARE), satisfaction with the
review meetings and health-related quality of life
Forecast 2
 Workshops with Clinical Psychologist
 Production of a video and training manual
 Recruitment of a minimum of 75 patients
 Assess their FCR by use of questionnaires, daily log (phone App) and FU
phone call
 Audio tape every review consultation
 The aim is to evaluate (and reduce) patients’ FCR by use of additional
training received
Forecast 2
 Society of Radiographers endorsement at end
 Training package will be made available for HCP to use nationwide via
Breast Cancer Now
Publications
 Y Yang, J Cameron, C Bedi, G Humphris (2018)
“Fear of Cancer Recurrence Trajectory during Radiation Treatment and Follow-up into Survivorship of Patients with Breast Cancer”
BMC Cancer

 G Humphris, Y Yang, L Barracliffe, J Cameron, C Bedi (2018)

“Emotional talk of patients with breast cancer during review appointments with therapeutic radiographers: effects on fears of cancer recurrence”
Supportive Care in Cancer (https://doi.org/10.1007/s00520-018-4484-7)

 M Van Beusekom, J Cameron, C Bedi, E Banks, T Kelsey, G Humphris (2018)

“Development, acceptability and feasibility of a communication skills training package for therapeutic radiographers to reduce fear of recurrence development in breast
cancer patients (Forecast 2)”
Pilot & Feasibility Studies 4: 148

 L Barracliffe, Y Yang, J Cameron, C Bedi, G Humphris (2018)

“Does Emotional Talk Vary with Fears of Cancer Recurrence Trajectory? A Content Analysis of Interactions between Women with Breast Cancer and their Therapeutic
Radiographers”
Journal of Psychosomatic Research January 106 41-48

 G Humphris, Y Yang, L Barracliffe, J Cameron, C Bedi (2017)

“Therapeutic radiographer responses to emotional talk in breast cancer patients undergoing radiotherapy: A longitudinal multi-level sequential study” Poster Presentation
International Conference on Communication in Healthcare (ICCH), Baltimore, USA

 Y Yang, J Cameron, G Humphris (2017)

“The relationship between cancer patient's fear of recurrence and radiotherapy: a systematic review and meta-analysis”
Psycho-Oncology 26: 6; 738 - 746
Forecast Website
 http://med.st-andrews.ac.uk/forecast/

 https://breastcancernow.org/news-and-blogs/news/scottish-trial-to-
train-radiographers-to-help-reduce-patients%E2%80%99-fears-of-breast-
cancer-returning

 https://breastcancernow.org/breast-cancer-research/our-research-
projects/forecast-2-designing-implementing-training-package-for-
radiographers-to-help-manage-patients-fear-of-breast-cancer-returning