Patsy Yates

Overview of a research program to improve needs based palliative care in Australia

BACKGROUND AND AIMS: Based on our experience of CST for oncology clinicians, we hypothesized that improvement in communication may be mediated by a modification of clinicians defence mechanisms. In order to test this hypothesis, 120 oncology clinicians interviews with simulated patients (60 interviews pre- and 60 interviews post-CST with a 6 months interval) are analyzed and compared to 120 interviews with simulated patients of a control group of 60 oncology clinicians who did not undergo CST (interval of 6 months).nMETHODS: Up to now 20 oncology clinicians of the CST group and 10 of a control group were included. Verbatim transcription of video-taped interviews were evaluated with the Defence Mechanism Rating Scales for therapists (DMRS-T), an adapted version of the DMRS.nRESULTS: The number of specific defence mechanisms in the 60 interviews ranged from 10 to 35 (M ¼ 20:93; SD ¼ 5:7). The three most frequent mechanisms were displacement (20.3%), intellectualisation (19.6%) and rationalization (16.1%). RESULTS indicated: A significant increase of the Overall Defence Functioning (ODF) score (ODF 4.29 ðSD ¼ 0:51Þ vs ODF 4.67 ðSD ¼ 0:36Þ; z ¼ 2:95; p ¼ 0:003) in the CST group. But no significant increase of the ODF score in the control group (ODF 4.02 ðSD ¼ 0:32Þ vs ODF 4.29 ðSD ¼ 0:53Þ; z ¼ 1:24; p ¼ 0:210). A significant increase of neurotic defence mechanisms (50.15% ðSD ¼ 1:41Þ vs 56.99% ðSD ¼ 0:98Þ; ¼ 2:27; p ¼ 0:023) and a decrease of immature defines mechanisms (45.21% ðSD ¼ 1:28Þ vs 36.46% ðSD ¼ 1:12Þ; z ¼ 2:84; p ¼ 0:005) in the CST group. A significant increase of the mature defences in the control group (1.86% ðSD ¼ 0:43Þ vs 8.75% ðSD ¼ 0:91Þ; z ¼ 2:37; p ¼ 0:018). No differences between the CST and the control group according delta (interview-post-interview-pre) for ODF score and delta for defences categories.nCONCLUSIONS: Preliminary results foster the hypothesis that CST may have an impact on the level of defence mechanisms.