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Psychosocial service use: a qualitative exploration from the perspective of rural Australian cancer patients

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Abstract

Purpose

This study aims to identify key issues associated with the provision of psychosocial care from the perspective of rural Australian cancer patients and determine culturally appropriate methods that may reduce barriers to service use.

Method

Seventeen purposively sampled adult South Australians who lived outside metropolitan Adelaide, had a diagnosis of cancer and various demographic and medical histories participated in semi-structured, face-to-face interviews. Participants also completed a demographic questionnaire. Qualitative data were analysed using thematic analysis.

Results

Five key themes were identified: (1) psychosocial support is highly valued by those who have accessed it, (2) having access to both lay and professional psychosocial support is vitally important, (3) accessing psychosocial services is made difficult by several barriers (lack of information about services, initial beliefs they are unnecessary, feeling overwhelmed and concerns about stigma and dual relationships), (4) medical staff located in metropolitan treatment centres are not sufficiently aware of the unique needs of rural patients and (5) patients require better access to psychosocial services post-treatment. Methods through which rural patients believe access to psychosocial services could be improved include: (1) providing more rural-specific information on psychosocial care, (2) improving communication between health care providers and referral to psychosocial services and (3) making psychosocial services a standard part of care.

Conclusions

Rural cancer patients want their unique needs to be recognised and to be treated differently to their urban counterparts. There is a need for more targeted and rurally relevant information for rural cancer patients, both to inform them of, and change their attitudes towards, psychosocial services. Other practical recommendations are also discussed.

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Notes

  1. Supported accommodation facilities are available for cancer out-patients and their carers to stay in at a low cost, during their cancer treatment. Social Workers are on-site and interaction between guests (e.g. at morning teas) is encouraged. Buses are available to take patients to several of the main treatment facilities as many rural people are reluctant to drive in the city and car parking can be problematic.

  2. Personal contacts were used when a particular type of patient needed to be represented and other means of recruitment did not facilitate this.

  3. The Accessibility/Remoteness Index of Australia (ARIA) is a standard index of remoteness that is based on accessibility by road to services. Classifications range from “Highly Accessible” (areas with scores between 0 and 1.84 where there is relatively unrestricted accessibility to a wide range of goods and services and opportunities for social interaction) to “Very Remote” (areas with scores >9.08–12 with very little accessibility to goods, services and/or social interaction) [22].

  4. Where necessary, psychosocial care was explained to participants as help with stress management, adjustment to cancer/coping, sleep, social support, decision making, communication skills, information, relaxation, pain management, interpersonal problems/conflict resolution, anxiety (often about the future), depression/low mood, thoughts about suicide, body image, sexuality/fertility, spirituality, accommodation and financial issues. It was suggested that this type of care may be delivered by people such as social workers, specialist nurses, counsellors, peer support workers (i.e. someone who has also been affected by cancer), psychologists and/or psychiatrists.

  5. That is, little new information was being obtained.

  6. The two participants who criticised counselling services nonetheless reported positive experiences with cancer support groups. One of these participants did not elaborate on why he found counselling a ‘waste of bloody time’ but the other said it was because the hospital counsellor kept encouraging her to ‘yell, scream, cry’ after her surgery while she was thinking ‘let's fix it up and move on’.

  7. The three participants who did not mention that they lacked information on psychosocial services received treatment in private hospitals.

  8. Not all participants were asked this question due to the unstructured nature of the interviews and interviewer error.

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Acknowledgments

The authors gratefully acknowledge the assistance provided by participants, the Spencer Gulf Rural Health School (Primary Health Care Research Evaluation and Development Bursary) (now UniSA) and Cancer Council SA.

Conflict of interest

No conflicts of interest to declare. The authors have full control of the data and if requested, are willing to make it available to Supportive Care in Cancer.

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Authors and Affiliations

  1. School of Psychology, The University of Adelaide, North Terrace Campus, Level 4, Hughes Building, Adelaide, South Australia, 5005, Australia

    Kate Gunn, Deborah Turnbull, J. Lindsay McWha & Matthew Davies

  2. Cancer Council Australia, Level 14, 477 Pitt Street, Sydney, NSW, 2000, Australia

    Ian Olver

Authors
  1. Kate Gunn
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  2. Deborah Turnbull
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  3. J. Lindsay McWha
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  4. Matthew Davies
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Correspondence to Kate Gunn.

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This manuscript is original, not previously published and not under concurrent consideration by any other journals.

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Gunn, K., Turnbull, D., McWha, J.L. et al. Psychosocial service use: a qualitative exploration from the perspective of rural Australian cancer patients. Support Care Cancer 21, 2547–2555 (2013). https://doi.org/10.1007/s00520-013-1812-9

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  • DOI: https://doi.org/10.1007/s00520-013-1812-9

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