"Moving Swiftly On." Psychological Support Provided by District Nurses to Patients With Palliative Care Needs

Background: Patients are living longer with incurable cancer, and for most of the time, they are at home. Psychological morbidity is high and increases with advanced disease and poor prognosis, and evidence suggests that patients' psychological needs at this time are not met. District nurses provide support visits to patients for long periods before they die. Little is known about district nurses' skills in detecting patients' concerns and meeting psychological needs. Objective: The aim of the study was to explore how UK district nurses describe and conduct early support visits with palliative patients and patients' perceptions of visits. We report 1 aspect of the findings: psychological assessment and support provided during early support visits at home. Methods: Six focus group were conducted with 53 district nurses. Interactions between 10 patients, their carers, and district nurses were observed and audio recorded during home visits. Patients and carers were also interviewed before and after the observation visits. Data were analyzed using a thematic approach. Results: District nurses described assessing and meeting patients' psychological needs informally through "chatting." Observation of practice, however, revealed avoidance behaviors when faced with patients' psychological concerns, exemplified by the statement "moving swiftly on," which was 1 district nurse's response to a patient's overt distress. Implications for Practice: District nurses have a potentially important role in assessing and meeting cancer patients' psychological needs, but appear to lack confidence and skills. District nurses need to be taught a simple intervention based on active listening and problem solving to assess and manage mild psychological morbidity.