Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Newly diagnosed head and neck cancer (HNC) patients experience an average of 11 unmet supportive care needs, among which psychological needs dominate. We designed and piloted a strengths-based oncology coaching intervention to address this gap in care, yet patient perspectives on this intervention are unknown.
Methods: The study applies an explanatory sequential design at an academic medical center in newly diagnosed HNC patients. Strengths-based oncology coaching was adapted from the strengths-based case management model and offered to patients as part of routine care by a social work-trained mental health clinician between 2/22-5/23. A minimum number of visits were offered to the patients during each phase of the survivorship journey (pretreatment phase: ≥2; on-treatment phase: ≥1; post-treatment phase: ≥1) and the intervention ended 6-months posttreatment. Initial eligibility criteria included moderate-severe distress (PHQ4 ≥6) and substance abuse; these were eventually dropped and the intervention was made available to all interested patients. Eligible patients were invited for semi-structured interviews: coaching participants (Group A); patients who only participated in a single coaching session (i.e., the strengths assessment, Group B); patients who declined to participate in coaching (Group C). Interviews were conducted between 7/23-4/24. Transcripts were thematically analyzed in NVivo 12.0 using a mixed deductive-inductive approach. A codebook was drafted, and two study authors independently coded three transcripts, yielding an interrater reliability of 0.77. The remaining transcripts were single-coded by either of the two study authors. Overall thematic findings and representative quotes were identified and interpreted by the research team.
Results: All 38 eligible coaching participants and 28 patients who declined coaching were invited to participate in the study. Twenty-four patients were interviewed (Group A: n=16; Group B: n=2; Group C: n=6) and exhibited the following characteristics: female: 45.8%; median age: 58 years; non-Hispanic white race/ethnicity: 62.5%; current smoking: 16.7%; heavy alcohol use: 8.33%; moderate-severe distress: 12.5%. Patients who were 1) coached or 2) coached and interviewed engaged in a median of 9 and 11 total coaching sessions, respectively. Thematic analysis yielded the following themes. First, many new HNC survivors expressed a variety of unmet intrapersonal (n=13/24, 54%) and extrinsic care needs (n=12/24, 50%). Second, coaching empowers patients by providing resources needed for the management of these care needs (n=14/16, 88%) and patients appreciated the ability to direct their own engagement with coaching (n=12/16, 75%). Third, the relationship with the coach is essential (n=14/16, 88%). Fourth, many patients did not rely on some constructs of the strengths model, including goal development and strengths recall (n=14/18, 78%). All 16 coached patients “strongly agreed” they would recommend coaching to other individuals diagnosed with cancer.
Conclusion: Most patients undergoing a strengths-based oncology coaching intervention benefitted from the psychosocial support provided and rated the intervention favorably. There are opportunities for intervention redesign, including emphasizing goal development in the posttreatment phase of care. These data support the design of a trial evaluating the effectiveness of strengths-based coaching on distress and perceived support.