The role of task shifting in psycho-oncology

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Published: 5 Sep 2023
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Dr PhuongThao Le - Boston University School of Public Health, Boston, USA

Dr PhuongThao Le speaks to ecancer about improving the mental health status of cancer patients and caregivers.

She discusses the lack of support, particularly in low-and middle-income countries, and outlines the next steps for improving psycho-supportive services.

My background is in global mental health and recently I have brought that experience over to the space of oncology and cancer supportive services. The idea is to improve the mental health status of cancer patients and caregivers as well. So I have a couple of projects here.

What I’m going to be talking about is the role of task shifting, which is the health system strengthening strategy where because of the lack of mental health professionals, psychologists, psychiatrists, that are basically not available in low and middle income countries, but there is a strategy where we can train and supervise laypeople, you and me, any person, even cancer survivors, to provide mental health supportive services so that we can increase their quality of life, their mental health status and then hopefully their treatment outcomes as well. So that’s the topic of my talk.

How does this strategy work?

In global mental health the strategy is task shifting and this actually came from the field of HIV work. It’s a manualised, evidence-based intervention, so the evidence base for the effectiveness of the intervention has been proven, but we put it in a format that is digestible. We train people on basic communication skills, empathic listening, motivational interviewing. Most of it is loosely based in the area of what you could call cognitive behavioural therapy. 

So, for example, one of the research projects that I’m doing is implementing a group-based, stress management intervention that was developed by the WHO called Self-Help Plus. It’s teaching people skills, very basic skills; it’s based on what’s called acceptance and commitment therapy. Basically we are taking healthcare workers, so in the Vietnam context the nurses are the ones who have a lot of interactions with the patients. So we’re asking them to facilitate these sessions and we’re also asking cancer survivors as peer facilitators. So you have a healthcare worker and a cancer survivor working together and they follow a curriculum of teaching the participants in the group certain skills, like an audio course almost, with some activities, in-person activities, in the course. So that’s one model.

The other model that we have implemented in Vietnam, have tested in Vietnam, is a peer mentoring model where we basically teach communication skills to cancer survivors so that they can improve their ability to communicate, to do that experiential sharing to other survivors and give them the supportive services.

Do these strategies vary by country?

There’s no one size fits all and even though we have an evidence-based intervention model, we always have to adapt it to the local context. The Self-Help Plus model that I’m basing the intervention on is community people but for the context of cancer care in Vietnam, that’s why we elected to have the healthcare worker as the lead facilitator and also having a peer to be a facilitator, a cancer survivor. Because we know that peer support works in providing the mental health support for cancer patients and other people with mental health conditions as well.

Anything else to add?

Psycho-supportive services in LMICs are very hard to come by so what I’m trying to do is to increase the capacity, the health systems’ capacity, the research capacity of the people that are here working in a multidisciplinary manner. So getting people to care about the mental health of cancer patients and caregivers.