Implementing and evaluating a four tier model of psychological support. Results from a three year study


Session type:

Kate Jenkins, Beccy Alberry, Sarah Pestell, Vivien North, Nigel North

Salisbury NHS Foundation Trust, Salisbury, UK


Implementing and evaluating a four tier model of psychological support. Results from a three year study


NICE guidance for Supportive and Palliative Care (2004) recommends a Four-Tier model of Psychological Support for patients and families. Level 1 requires compassionate communication and information giving. Level 2 contains staff such as nurses, doctors and others. Staff at Level 2 should be screening for psychological distress at diagnosis, during treatment, end of treatment and recurrence and should intervene using techniques such as problem solving and psychoeducation. Levels 3 and 4 are mental health professionals.


The model has been implemented through the provision of a team to provide Levels 3 and 4 of the model, consisting of a Clinical Psychologist, Counsellor, Social Worker and Assistant Psychologist. A teaching programme was developed for Level 2, in the screening and psychoeducation skills, evaluated through the use of pre and post confidence questionnaires, with six month follow-up. The team is evaluated through patient and staff satisfaction questionnaires. Audit of medical records assesses screening incidence at the four time points.


Results for the teaching programme show statistically significant improvements in all areas assessed (p<0.01, N=178), maintained at follow-up. Results from baseline and repeated audit will be presented. Data from patient and staff satisfaction surveys will be presented.


The teaching programme is effective in improving staff confidence and improvements are maintained. It is hypothesised that the implementation of the model will have increased the numbers of people screened for distress and patient satisfaction with psychological support.


This project is only possible due to the generosity of the Wessex Cancer Trust.