Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Chu CY (1), Mo SL (1), Lam YH (1), Yuen KK (2), Siu WK (2)
Affiliation :
(1) Medical Social Services (Hospital Authority), Queen Mary Hospital (2) Department of Clinical Oncology, Queen Mary Hospital
Introduction :
Cancer patients face physical and emotional challenges along the illness journey. Studies found that cancer patients have higher suicide risk when compared to that in general population ( Henson et al.,2019; Zaorsky et al., 2019; Men et al., 2020). Most of suicide researches focus on suicide death, suicide ideation and its’ related risk factors. However, limited study has been conducted on identifying effective suicide prevention intervention strategies. After implementing the Safety Plan Intervention (SPI) which was developed by US National Action Alliance for Suicide Prevention in local setting for years, it’s effectiveness has been reviewed.
Objectives :
To examine the effectiveness of SPI in suicide prevention for cancer patients in local setting.
Methodology :
- Time series control group design and purposive sampling were adopted in the study. Incurable cancer patients in Department of Clinical Oncology during Jul 2020 – Mar 2023 were screened by scales of Distress Thermometer (DT), General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) in routine service. Those patients identified with suicidal risk by PHQ-9 or self-disclosure of suicidal ideation/behavior/attempt were grouped as experimental group. Medical social worker (MSW) firstly conducted comprehensive risk assessment by standardized measurement tools and then worked out the SPI with patient directly. SPI included (1) Identifying warning signs, (2) Enhancing effective coping strategies, (3) Increasing social support; (4) Identifying emergency contact person for help, (5) Providing Professionals / agency contact for help during office & non-office hours and (6) Making the environment safe. During the planning process, patient’s self-awareness on emotional needs and the motivation to seek support was strengthened. To ensure patient’s easy access of multi-dimensional support services especially during non-office hour, handy resources kits were distributed to them in form of caring packs. Ongoing monitoring of suicidal risk was conducted in 6 months’ time. Patients with psychosocial needs including those with suicidal risk under routine care of MSW during July 2018 – Jun 2020 were grouped as control group.
Result & Outcome :
- 94 and 192 cancer patients recruited in experimental group and control group respectively. DT, GAD-7 and PHQ-9 were used to measure patients’ emotional change and suicidal risk in 3 time points. i.e. case intake, third month and sixth month after case intake. Repeated Measured Anova was used to measure the change over 3 time points. In experimental group, the mean score of PHQ-9, reflecting depression level and suicidal risk, reduced from 15.45 to 12.62 significantly (p<0.001). The mean score of GAD-7 indicating the anxiety level has also been dropped from 12.03 to 9.05 ( p<0.001). Despite the reduction of mean score of GAD-7 and PHQ-9 in control group, the change was not statistically significant. To conclude, SPI provides a structured framework in comprehensive risk assessment, suicide- specific psychosocial intervention and continuous monitoring for patients with suicide risk. The guided intervention ensured the delivery of multi-dimensional support to patients and thus reduced the risk of suicide.
