Psychological

therapies and support

framework for people
affected by cancer

April 2022
Contents
Foreword ............................................................................................................................................................. 3
Psychological therapies and support framework ................................................................................................ 5
Introduction ..................................................................................................................................................... 5
Background and purpose................................................................................................................................. 5
Policy context .............................................................................................................................................. 6
Remote/digital delivery and the COVID-19 pandemic .................................................................................... 7
Definitions and guiding principles of psychological support ........................................................................... 8
Psychological therapies and support framework .......................................................................................... 10
Health and Wellbeing Model ..................................................................................................................... 10
Framework for assessment and intervention / management ...................................................................... 11
Implementation and supporting documents ................................................................................................ 15
Referral patterns and pathways ................................................................................................................ 15
Education and training grid ....................................................................................................................... 15
Implementation governance and measurement ...................................................................................... 16
Clinical quality statements ........................................................................................................................ 16
Service quality statements ........................................................................................................................ 16
Conclusion ................................................................................................................................................. 17
References ..................................................................................................................................................... 18
Acknowledgements ................................................................................................................................... 19
Appendix 1: Psychological support pathway ................................................................................................. 20
Appendix 2: Psychological support referrals guide and case studies............................................................ 21
Appendix 3: Education and training grid ....................................................................................................... 29
Appendix 4: Quality statements self-assessment template .......................................................................... 35
Appendix 5: Psychological therapies and support framework working group membership ........................ 40

Psychological Therapies and Support Framework - April 2022 2

Foreword
Recognition that the assessment of psychological needs and provision of support should
start from as early as possible in a person’s journey through cancer is welcome1. It is clear
from patient reported outcomes that psychological interventions prior to surgery for cancer
can impact somatic symptoms and quality of life as well as psychological well-being2. In
order to be person centred and improve long term outcomes, psychological therapies and
support need to be available in a seamless way across the prehabilitation (prehab) –
rehabilitation (rehab) continuum.
The West of Scotland Cancer Network (WoSCAN) psychological therapies and support
framework brought together a wide range of key stakeholders to create a shared vision of
good practice. Stakeholders included NHS and third sector organisations located in the
West of Scotland who provide psychological support to people undergoing cancer treatment
and their supporters. In setting out an agreed, evidenced based model, their framework
increased understanding of what good, person centred psychologically informed care and
support looks like, the practical steps that facilitate this and created tools to audit and
demonstrate quality. In this way, it has been an effective structure for those offering
psychological support and interventions to understand and support each other’s roles, and
to identify both good practice and service gaps.
As such, it was a logical decision, as chairs of the psychological subgroup of the Cancer
Prehabilitation Implementation Steering Group (CPISG), to use the existing WoSCAN
framework as our starting point for a new national Framework. We have had to make
relatively few adaptations and amendments to ensure it is appropriate across the continuum
from prehab to rehab. One significant change that was made was to integrate the previous
separate Implementation Pack into the Framework document itself, as we believed this
resulted in a more concise and comprehensive approach. While not forming part of the
Framework itself, recommendations have been made to support wider implementation and
strengthen the commitment to delivering on the outcomes contained within.
We are grateful for the enthusiasm and support of colleagues in supporting this process.
We are also excited that this work has provided the opportunity to adopt the framework on a
Scotland wide basis, prompting discussions about the centrality of psychological support
and therapy in cancer care across all Board areas and third sector organisations.
As co-chairs, one working a third sector organisation based within a national cancer centre
and one in the NHS, we have both been acutely aware of the impact of the COVID-19
pandemic not only on those undergoing cancer treatment, but also NHS staff and those
delivering care and support in the third sector.
COVID-19 has increased the rate and severity of distress experienced by patients and their
families, including fears of infection, changes to treatment delivery, increased social
isolation and reduced availability of support. Furthermore, the effects of COVID-19 have not
been felt equally across the population with some groups, particularly those in poverty,

1
Macmillan Prehabilitation for People with Cancer
2
Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, et al. (2015) Review of psych interventions in
cancer prehab: Psychological Prehabilitation Before Cancer Surgery: A Systematic Review. Annals of surgical oncology.
22(13):4117–23

Psychological Therapies and Support Framework - April 2022 3

young people, ethnic minority communities and those with disabilities or in residential care,
more affected than others.
The requirement for social distancing and increase in remote delivery of care (via telephone
or video link) has changed the way cancer care is delivered and the accessibility and
availability of both third sector and NHS support. While this has in some cases extended
the reach of support available it has also changed what support looks and feels like for
people affected by cancer. For some this is experienced as more disjointed and less
containing care and actual or perceived delays in care or diagnosis.
At the same time, health and social care staff are coping with intense service pressures and
a backlog of demand in many areas while third sector services have seen their ability to
deliver services affected by restrictions and funding challenges. Stress and burnout levels
in staff are subsequently very high (in 2021, 44% reported feeling unwell from work related
stress).
All of these factors underscore the need for a robust and well understood framework for
how psychological therapy and support can be provided by the public and third sector
working together from the first discussions about a possible cancer diagnosis onwards.
Non-visible but clinically significant distress can easily be missed in clinic and treatment
appointments, and this is likely to be magnified in socially distanced services, and more
likely to be hidden by a focus on practical concerns. A clear framework is also helpful in
highlighting the inequity which makes services less accessible to some in our communities.
We recognise that at the time of writing, staff may have limited capacity to adopt new
practices or attend training, however, a framework which clearly describes the good
practice we aspire to is an essential step in working towards this. In addition, supporting
staff to deliver psychologically informed care and support is as important for their own
wellbeing and job satisfaction, as it is for patient experience and outcomes.
We would like to thank all those who have contributed to this process of revising and
incorporating prehab into the framework. We are committed to continue to work across the
NHS and third sector to strengthen and expand psychological support and therapy services
across Scotland, and to generate the evidence needed to further improve and develop
these for people with cancer and their families.

Helen Moffat and Gillian Hailstones

Co-chairs

Psychological Therapies and Support Framework - April 2022 4

Psychological therapies and support framework

Introduction
The Psychological Therapies and Support Framework has been developed by a multi-
disciplinary, collaborative group which contained representatives from NHS Boards, Third
Sector organisations and Social Care organisations, see Appendix 5 for group membership.

The purpose of the Framework is to provide a structure to define the service which should
be available to all those affected by cancer (16 years and above) and those identified to
have specific psychological support needs3. The Framework is equally relevant to all
services independent of their sector i.e., health, social care and the third sector.

The overall aim is to bring existing services together in a collaborative manner and illustrate
a good practice model thereby providing equitable and efficient access to the appropriate
services for people affected by cancer.

Background and purpose

In recognition of the impact of the COVID-19 pandemic on mental health and wellbeing,
cancer services and individual lives more generally, it is timely to look at look at
psychological care and support for people affected by cancer across Scotland, developing a
matched care model of psychological therapy and support provision. This model should
build on the work already completed in the West of Scotland, encompass all stages of the
cancer journey, be relevant for people across Scotland who are affected by cancer, and
incorporate the important role of charitable organisations in addition to health and social
care services. The purpose of the model will be to enable those working with people
affected by cancer to discuss, signpost and refer to appropriate services to best meet the
person’s needs. It will also be useful for commissioners, service providers and managers to
help them understand current service provision and service gaps. This will facilitate future
service development, ensuring services are designed according to the significant emotional
needs of people affected by cancer.

It is well evidenced and documented that psychological distress is a significant problem for
people affected by cancer. People recently diagnosed, those who are receiving treatment,
those who have completed treatment, those receiving palliative care, and those who are
caring for people with cancer, all report that the emotional aspects of cancer are difficult to
cope with. Research suggests the post-treatment phase can be particularly volatile for
mental well-being, in almost half of all cancer cases emotional effects are cited as being
more difficult to cope with than physical and practical effects of cancer (Mental Health
Foundation, 2018; Macmillan Cancer Support, 2006). The emotional impact of cancer
ranges from “normal feelings of vulnerability, sadness and fears to problems that can
become disabling such as depression, anxiety, panic, social isolation and spiritual crisis”
(NCCN, 2015; NCCN 2019), with the prevalence of mental health difficulties such as
anxiety or depression in people living with cancer being about 33% (Mehnert et al, 2014).
Psychological therapies have been shown to be effective in reducing distress, improving

3
The Framework is applicable to adult patients with cancer and their carers (irrespective of age).

Psychological Therapies and Support Framework - April 2022 5

quality of life, and reducing contact with healthcare services (NES, 2002). Yet almost a
quarter of people don’t feel confident about knowing how or where to access available
emotional support (Macmillan Cancer Support, 2006) and in Scotland’s Cancer Patient
Experience Survey (Scottish Government, 2019) 13% of respondents felt they had not been
supported emotionally or psychologically by healthcare professionals, whilst 40% of those
who felt they needed help from the third sector (approximately 60% of total respondents)
did not receive any information or support from them. Variability in signposting, onward
referral and service provision, including across NHS Board areas, compounds the difficulty
of accessing appropriate person-centred support.

In 2004 NICE developed a model of psychological and supportive care for people with
cancer. This model outlines different levels of support which may be required by people
diagnosed with cancer and it specifies which health and social care professionals would
have the competences to provide support at each level. While a useful model, it was
developed with a focus on individuals around the time of diagnosis and treatment and so it
does not support the full cancer pathway. The model also does not reference support
provided by charitable organisations which play a key role in the provision of emotional
support.

With the above in mind and in the context of Scotland’s Transforming Care After Treatment
Programme, multi-agency partners in the West of Scotland in 2015 created the
‘Psychological Therapies and Support Framework for People Affected by Cancer’. This
framework was subsequently recognised by the Mental Health Foundation as good practice
and supportive in ensuring people get the right support at the right time (Mental Health
Foundation, 2018).

In 2019, Macmillan Cancer Support, the National Institute of Health Research (NIHR)
Cancer and Nutrition Collaboration and the Royal College of Anaesthetists (RCOA)
published ‘Prehabilitation for People with Cancer: Principles and guidance for
prehabilitation within the management and support of people with cancer.’ The guidance set
out how prehabilitation can promote personal empowerment by fostering a sense of control
and purpose and by improving quality of life; improve physical and psychological resilience;
and improve long-term health through the adoption of positive behaviours (Macmillan
Cancer Support, 2019). Prehabilitation should therefore, be part of the rehabilitation
continuum, start as early as possible (and in advance of any cancer treatment), and should
include exercise/activity, nutrition and psychological support (be multi-modal).

Policy context
Several Scottish Government policies have relevance to this aspect of cancer care, not
least the Mental Health Strategy: 2017-2027 which calls for parity of esteem between
physical and mental health.

The Scottish Government has also outlined the need to regularly and routinely assess the
holistic needs of people affected by cancer to inform the development and delivery of
individualised care plans. This should include psychological therapy and support where
indicated.

Psychological Therapies and Support Framework - April 2022 6

‘Recovery and Redesign: An Action Plan for Cancer Services’ sets out three key aims, one
of which is to ‘adopt a ‘Once for Scotland’ approach with the purpose of ensuring patients
across Scotland receive equitable access to care and treatment. The strategy also sets out
actions which support personalised care. Transforming Cancer Care will ensure all cancer
patients have access to a key support worker and thereby receive dedicated financial,
practical and emotional support; and the single point of contact will provide an opportunity
for people to discuss questions or anxieties related to clinical care (Scottish Government,
2020). In recognising the role of cancer prehabilitation the strategy also sets out actions
which will test and evaluate prehabilitation in Scotland, whilst supporting the development
of frameworks and resources which should drive quality and consistency across services.
These frameworks specifically include one which addresses psychological therapy and
support.

Remote/digital delivery and the COVID-19 pandemic

The COVID-19 pandemic has brought unprecedented change to the way services are
delivered. Many aspects of service delivery, including the psychosocial care of people
affected by cancer, and service development and training associated with this, are now
delivered through remote means i.e., via the telephone or through various digital tools and
platforms such as NHS NearMe. In the early stages of the pandemic this allowed
consultations and visiting to continue whilst reducing the risks associated with ‘in-person’
working. As risks associated with the pandemic lessen, it is important that the benefits of
this type of working are not lost, the limitations are recognised, and a blended model of
working developed. Many benefits of remote working include ease of access for frail
patients and those with chronic and/or relapse and remitting conditions, those living distant
from their place of health or social care, and in reducing travel time and costs for patients
and staff. However, there are also cautions in moving to full systems of remote working,
and accessibility and patient preference must be given due consideration. In addition, when
it comes to delivery of psychological wellbeing, informed practice and therapies, additional
consideration is needed to the effectiveness of these interventions when delivered digitally.
The limited evidence to date suggests that psychological therapy delivered via digital
means can be effective, acceptable to patients and providers, and cost effective (HIS
2021a; HIS 2021b). This statement is caveated by recognising that the research to date is
sparse and what there is, is limited in scope, focussing on mild to moderate anxiety and
depression and on particular patient populations. At the time of writing there is limited or no
evidence for more complex presentations and the breadth of population represented within
those affected by cancer. Careful assessment is therefore advised in determining suitability
of use of digital technologies for delivery of psychological therapy taking account of the
issues noted above.

The way in which many people interact socially has also been changed by the pandemic
with the number of in-person opportunities for support within communities being more
limited. It is therefore important that we are mindful of this when adopting a health and
wellbeing model of psychological support and care noting that ‘Peer support’ and
‘Connected communities’ may look and feel very different to those involved. We may also
find that resilience, planning for the future and accepting change are all further challenged
by the pandemic and innovative means of connection and support may need to be

Psychological Therapies and Support Framework - April 2022 7

explored, with additional practical support offered to those who may otherwise find these
solutions untenable.

Definitions and guiding principles of psychological support

The term psychological therapy and support refers to a range of interventions to help
people understand and make changes to their thinking, behaviour or relationships to relieve
distress and to improve their functioning, well-being and quality of life.

The following guiding principles and key messages underpin the Psychological Support and
Therapies Framework. Appendix 1 provides an overview of the pathway which supports the
Framework thereby ensuring execution of these principles.

Guiding principles:
• it is expected that a person diagnosed with cancer will have supportive and
psychological needs arising from their cancer diagnosis and/or care pathway
• clinical teams should avoid ‘pathologising’ distress that is understandable in the
circumstances
• clinical teams should acknowledge expressed distress in a validating manner rather
than minimising it
• there should be early identification of the person’s support needs and early
intervention, to avoid escalation of emotional and psychological issues and facilitate
access to treatment where this is a precluded by psychological distress (e.g. phobias
associated with needles and small/confined spaces)
• shared-decision making should be enabled with personalised care and support
planning central to all care
• the focus of care should be the ‘whole person’ (not just the physical aspects of
disease) and their supporters. This should be approached proactively with wellbeing
embed within ‘normal care’ from the beginning of the care pathway and maintained
throughout
• significant distress should be detected and managed appropriately, utilising relevant
screening tools
• services may need to be labelled and presented to people in a way which avoids
stigma and overcomes resistance. For those with low level need that may be
‘someone to talk to’ rather than ‘counselling’ or ‘psychology’ However, those
requiring input at level 3 or 4 should be informed that they have been identified as
requiring more specialised support and that it will be an interactive process.
• wherever possible there should be a focus on ‘wellness’, not ‘illness’
• the approach to care should encompass the quality of life as well as the quantity of
life
• psychological care should be integrated into disease-specific pathways of care, not
organised separately
• the person should be supported in remaining as emotionally independent as possible
during the cancer pathway
• the focus of care should be to support the person to resume as normal and healthy a
life as possible

Psychological Therapies and Support Framework - April 2022 8

 • for people finishing treatment, care should build their confidence and enable
individuals to cope after discharge from active treatment

Key messages:
• emotional effects are a normal part of the cancer pathway
• people should be able to easily access appropriate supportive and psychological
care, which forms a normal part of the overall care package
• for many, cancer is increasingly becoming a long-term condition rather than a
terminal illness – many people recover sufficiently to be able to pick up their old lives
again, therefore a focus on health and wellbeing is crucial
• individuals should be supported to be as involved in their care as they want to be
with shared decision making and person-centred care and support planning central
to all interactions

Psychological Therapies and Support Framework - April 2022 9

Psychological therapies and support framework
A two-stage framework has been developed, the initial model details the general approach
for all people diagnosed with cancer, whilst the second provides the approach for those
people identified, via needs assessment and risk stratification, to have specific
psychological need.

Health and Wellbeing Model

Relevant to all people diagnosed with cancer - if concern identified further assessment and referral required

Figure 1: Health and wellbeing model (adapted from Alzheimer Scotland’s ‘5 Pillars
Model of Post Diagnostic Support’ (2011))

• assessment and risk stratification

o a named individual will carry out an assessment of needs, and a tailored plan
for meeting these, to enable people to maximise their health and wellbeing
before, during and after treatment

Psychological Therapies and Support Framework - April 2022 10

 o health and wellbeing approach that aims to educate and empower people to
manage their condition and keep them as fit and healthy as possible
o assessment should continue throughout the pathway, not solely at diagnosis
and end of treatment
• person centred approach to supporting and understanding symptoms / management
o the focus of care is on the individuals needs arising from the assessment. A
named individual will provide information and support to enable understanding
of treatment, symptoms and rationale for referral on if required
• keeping people connected to communities
o named individual to encourage and support individuals to link with peer
groups and develop ways to engage with social groups, in order to help
people to remain as emotionally independent as possible
o signposting to relevant services and support groups, e.g., information
services, benefits advice, complementary therapies, support groups etc.
• peer support
o named person to signpost to and encourage individual to seek peer support
o peer support can be very valuable in helping individuals come to terms with
living with uncertainty, by finding coping mechanisms, and in maintaining their
wellbeing and resilience
o peer support can be delivered through one-to-one support or in group
situations
• living with cancer and resilience
o at the end of treatment many find the fear of the cancer returning is
heightened; living with uncertainty can be overwhelming. This may be
compounded by a lack of trust in the body and an overall lack of confidence
o gaining control may take some time. Improving resilience will help. Developing
resilience begins with simple actions or thoughts that are practiced, such as
planning for the future (immediate and longer-term) and learning to accept
change
o health promoting messages should be delivered at all appropriate stages of
the pathway. Support should also be offered as necessary to help people to
adopt/resume as healthy a life as possible.

Framework for assessment and intervention / management

The second stage of the framework is for those individuals identified, through needs
assessment and risk stratification process, who require further support. Once again, we
must be mindful of how care and support can be effectively provided within this context,
recognising that some elements may be limited by infection control/risk reduction strategies.
Care plans should therefore be co-produced, personalised and regularly reviewed to ensure
they meet individual needs irrespective of level of intervention.

Psychological Therapies and Support Framework - April 2022 11

Figure 2: Assessment and intervention model

• levels of intervention – 1 to 4
o identification of appropriate level of intervention (from 1: information provision
to 4: mental health specialist assessment) using validated tool / specialist
assessment
o Appendix 2 provides an overview of the levels of intervention and appropriate
referral pathway
• referral and signposting
o individuals referred on appropriately given relevant intervention level, as
defined above
o individuals signposted to available services /information sources.
o local information is available on services provided across Scotland, by partner
organisations
o cross referral between partner organisations should be standard and
pathways should be developed to enable this. Cross referral is important to
ensure that people reach the most appropriate service as per their individual
needs

Psychological Therapies and Support Framework - April 2022 12

 o onward referrals should be clearly explained, and consent obtained in
advance
o all staff are responsible for appropriate communication to ensure continuity of
care and avoid duplication
o it is important that all individuals undertaking assessment are objective in their
referral and signposting of people to other services
• psychological support/ intervention
o evidence based interventions may be delivered in a variety of settings, e.g.
cancer services, local authorities, or third sector. These may include: psycho-
education, problem solving techniques, solution focused therapy, counselling,
mindfulness, cognitive behavioural therapy or acceptance and commitment
therapy. Other emerging evidence based therapies may also develop in
future. The impact of such treatments will not only positively impact quality of
life but may facilitate shared-decision making when complex decisions are
required and enable a person to engage in life-extending and/or life-
enhancing treatments when phobias are present (e.g. needle and
small/confined spaces)
• complementary therapies
o complementary therapy will provide a range of therapies such as massage,
Reiki, reflexology, and relaxation which complement the clinical
treatments. Some of the benefits can be improving a person’s range of
mobility, muscle pain and tension. It can also help alleviate stress, provide
relaxation and therefore aid supported self-management approaches
• social connectedness
o in order to reduce the risk of isolation and loneliness, whilst simultaneously
building resilience and independence, people will be supported to connect into
their local communities
o people will be signposted to agreed services and support groups, e.g.,
information services, welfare advice, faith groups, hobby groups (such as
gardening, choirs, dancing), carers groups and support groups
• self-management
o self-management is a set of approaches which aim to enable people living
with long term conditions to take control and manage their own health
o those working with people affected by cancer have a vital role to play in
supporting self-management, ensuring that people are engaged, empowered
and supported through collaboration with healthcare professionals, carers and
the wider community
• enablement
o interventions based on health behaviour theory are not guaranteed to
succeed, but they are much more likely to produce desired outcomes. Those
most likely to achieve desired outcomes are based on a clear understanding
of targeted health behaviours, and the environmental context in which they
occur
o lifestyle factors like what we eat, how active we are, the amount of alcohol we
drink, if we smoke and life circumstances e.g., finances etc. have a significant

Psychological Therapies and Support Framework - April 2022 13

 impact on our health and that of our communities. The impact of wider socio-
economic factors and deprivation should influence and support how
individuals and communities can be approached. Many of us in our day-to-day
work can support our clients to consider the impact of these factors on health
and wellbeing and address what matters to them. This is encouraged with
every interaction presenting an opportunity for health promotion
o where possible going to communities where deprivation and diversity exists,
in partnership with trusted local groups, could optimise access to otherwise
excluded or disadvantaged groups
o training can support practitioners to identify factors which influence decisions
to change and consider the impact of health inequalities, introduce
communication skills including open questioning, reflecting, giving feedback
and summarising
• health and wellbeing
o psychological support and therapies can build an individual’s confidence and
resilience in coping with discharge from active treatment, and in resuming as
normal and healthy a life as possible
o health and wellbeing events are delivered in most areas; they cover a range
of educative and informative events, e.g., nutrition, exercise, smoking
cessations and management of anxiety

Psychological Therapies and Support Framework - April 2022 14

Implementation and supporting documents

The overall aim of the Framework is to bring existing services together in a collaborative
manner and illustrate a good practice model, thereby providing equitable and efficient
access to the appropriate services for people affected by cancer. However, the presence of
a Framework will not in itself achieve this aim. For it to be achieved, the Framework must
be adopted by all partners in Scotland, including health and social care and the third sector
who provide core elements of psychological support to people affected by cancer. This best
practice framework includes several tools which focus on referrals, education, governance
and measurement; each is designed to aid adoption of core practices and embed clinical
guidance in service provision. Existing structures, e.g., Managed Clinical Networks, Patient
Support Groups, Third Sector forums etc. should also be utilised to promote the Framework
and raise awareness of the Guiding Principles and Key Messages.

Pan-Scotland adoption should promote trust in interagency working through a common

standard and closer working relationships, it will also further the potential for accessible and
timely care and support.

Referral patterns and pathways

In Appendix 2 you will find an overview of the levels of intervention, referral criteria, method
of assessment and possible interventions at each level of support. The criteria at each level
are not exhaustive, rather they are designed to provide an indication of support needs.
Case study examples of clinical cases at each of the four levels are also provided to help
staff assess and refer patients appropriately given presenting criteria.

It should be noted that there are particular points in the patient pathway at which we might
expect people to be more vulnerable and when we should be assessing the need for help.
Often these vulnerabilities are heightened during transitions of care, so it is important that
consideration is given to proactively planning for those points. When bereavement occurs,
support for carers and families is available from several services.

Education and training grid

This Education and Training Grid (See Appendix 4) details the knowledge and
competencies required at each level of intervention (based on NICE guidance and relayed
throughout the Framework), the likely interventions utilised by each staff group and
recommended core training at each level. The core training tools included have been
mapped against the core competencies outlined within ‘A Competence Framework for
Psychological Interventions with People with Persistent Physical Health Problems’, work
commissioned by NHS Education for Scotland (NES) and launched in 2016 providing a
robust evidence base to support the inclusion of these materials.

All NHS and non-NHS organisations can access training resources available through Turas.
Training programmes delivered by NHS Education Scotland (either online or face to face)
can be accessed by both NHS staff and partnership staff (e.g., Maggie’s).

Psychological Therapies and Support Framework - April 2022 15

Implementation governance and measurement
To drive improvement and ensure high quality interventions are delivered irrespective of
sector/provider, quality statements have been developed for monitoring and evaluation
purposes. These have been adapted from those developed by Scottish National Advanced
Heart Failure Service and informed by learning from the WoSCAN implementation. The
Quality Statements focus on two key areas, Clinical Practise and Service Delivery.

Clinical quality statements

1. People affected by cancer should have ready access to the appropriate level of
evidence based psychological intervention appropriate to their needs at all parts of
their treatment pathway
2. Recognised and agreed screening and assessment tools should be used to ensure
an appropriate, individualised plan for meeting the identified needs of people
affected by cancer is agreed
3. People affected by cancer receiving a psychological intervention should have their
response to treatment monitored and the delivery of treatment adjusted in
response to outcomes

Service quality statements

1. Services should have a clearly defined pathway detailing the provision of
psychological assessment and care for people affected by cancer, including clear
referral processes and good accessibility for referrers and service users
2. All individuals working within relevant services should complete appropriate
training to ensure their knowledge and skills are appropriate for the level of
psychological care provided
3. All professionals delivering psychological interventions should have regular and
routine access to consultation and/or supervision to optimise competency and
delivery of interventions

Utilisation of these Quality Statements will inform and measure service delivery and
improvements within organisations at a local level. Open-reporting will allow Regional and
cross organisational comparisons and benchmarking, furthering opportunities for
improvement and cross-agency/sectoral relationship building. The self-assessment
template in Appendix 4 details the data measures that will help to establish a baseline
position and also support on-going evaluation of implementation and service improvement.

To ensure successful implementation of the Framework it is recommended that Boards and

partner organisations undertake an annual quality review by participating in the self-
assessment exercise and report findings through their own relevant governance group to
ensure visibility of the results and agreement on actions. This should not only help to
position psychological care and support as a core component of cancer care but should
provide an appropriate platform for shared learning and coproduced action plans for
ongoing internal improvement.

Psychological Therapies and Support Framework - April 2022 16

It is further recommended that these findings are shared at local, regional and national level
in order to support implementation of the Framework as a national document and prevent
dilution and divergence over time.

Conclusion
Cancer diagnosis and treatment continues to evolve and change as our knowledge and
understanding of the disease grows. As we utilise ever more complex and targeted
treatment regimens, it is essential that we continue to grow and develop the psychological
care and support that people affected by cancer receive. Through provision of the right
psychological support, in the right place at the right time, people affected by cancer can be
better equipped emotionally and psychologically to face their challenges. Access to this
high-quality psychological support should be equitable to all regardless of geographical or
socio-economic factors.

In order to achieve this, it is more important than ever that all care sectors will work
collaboratively, ensuring care and support feels seamless, connected and easily accessed.
This co-designed Framework supports a shared understanding and agreement of referral
pathways, optimal access to high quality service provision and a mechanism to monitor
both success and challenges at local, regional and national level.

By providing a platform and a framework for NHS, Social Care and Third Sector
organisations to work collaboratively this Framework can support and optimise existing
service provision. Through continued close working and continued development of trust and
respect for the quality of services provided at all levels in all sectors we can ensure that
people affected by cancer are truly put at the centre of care planning and delivery.

Psychological Therapies and Support Framework - April 2022 17

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digital delivery of real-time psychotherapy compared with face-to-face therapy for
depression or anxiety (including PTSD)
http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/topi
cs_assessed/assessment_01-21.aspx

Macmillan Cancer Support (2006) Worried sick: The emotional impact of cancer. Opinion
Leader Research, UK. Available at:
https://www.macmillan.org.uk/documents/getinvolved/campaigns/campaigns/impact_of_can
cer_english.pdf

Macmillan Cancer Support (2019) Rehabilitation for People with Cancer: Principles and
guidance for prehabilitation within the management and support of people with cancer.
Available at: https://www.macmillan.org.uk/healthcare-professionals/news-and-
resources/guides/principles-and-guidance-for-prehabilitation

Mehnert, A., Brähler, E., Faller, H., Härter, M., Keller, M., Schulz, H., Wegscheider, K.,
Weis, J., Boehncke, A., Hund, B. and Reuter, K. (2014) Four-week prevalence of mental
disorders in patients with cancer across major tumor entities. Journal of Clinical Oncology,
32(31), pp.3540-3546.

Mental Health Foundation (2018) Supporting the emotional and mental health needs of
people with cancer. Available at: https://www.mentalhealth.org.uk/sites/default/files/mh-
needs-people-with-cancer.pdf

National Comprehensive Cancer Network (2015) Distress Management Guideline

National Comprehensive Cancer Network (2019) Distress Management Guideline Available

at: https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1431

NICE (2004) Guidance on Cancer Services. Improving supportive and palliative care for
adults with cancer: The Manual. Available at:
https://www.nice.org.uk/guidance/csg4/resources/improving-supportive-and-palliative-care-
for-adults-with-cancer-pdf-773375005

NHS Education Scotland Clinical Psychology Workforce Planning Group (2002)

Contributions of Psychology to Cancer Care. Available at:
https://www.isdscotland.org/wf_psychology/clinicalpsychologywfp.pdf

Psychological Therapies and Support Framework - April 2022 18

Scottish Government (2017) Mental Health Strategy 2017-2027: The Scottish Government's
approach to mental health from 2017 to 2027 – a 10 year vision. Available at:
https://www.gov.scot/publications/mental-health-strategy-2017-2027/

Scottish Government (2019) Scottish Cancer Patient Experience Survey 2018: National
Report. Available at: https://www.gov.scot/publications/scottish-cancer-patient-experience-
survey-2018-national-report/

Scottish Government (2020) Recovery and Redesign: An Action Plan for Cancer Services.
Available at: https://www.gov.scot/publications/recovery-redesign-action-plan-cancer-
services/

Acknowledgements

Thanks go to all involved in the development of this Framework, including group members
(existing and former), those involved in the consultation phases and also those whose work
informed the overall purpose, scope and direction. Thanks also to everyone involved in the
original West of Scotland Cancer Network Psychological Therapies and Support
Framework, and to Dr Mairi Albiston, Clinical Psychologist at NHS Education Scotland for
her continued guidance on the training and education grid.

Psychological Therapies and Support Framework - April 2022 19

Appendix 1: Psychological support pathway
General Approach:
• It is expected that a person diagnosed with cancer will have supportive and psychological needs arising from their
diagnosis and/or care pathway
• Supportive and psychological care should be presented as a core part of the overall care package for those with a
cancer diagnosis
• Systematic support should be offered to ensure that no-one who might benefit misses out
• Supportive and psychological care needs should be identified as early as possible to improve the overall outcome
and avoid escalation of problems later on
• Regular enquiries should be made about the individual’s emotional and psychological state, as distress may not
be revealed at the first or second enquiry. Distress may be expressed as concerns about issues like money, work
and carer responsibilities
• The needs of family members and/or carers should also be considered
• As the support provided by cancer services will be time-limited, people should be encouraged to remain
emotionally independent in the longer term

All those diagnosed with cancer: Specialist Psychological Assessment

• Proactively enquire about emotional state
• Reassure and encourage
Those experiencing moderate to severe psychological distress
• Provide general emotional and
or psychopathology:
psychological support
• Offer a choice of interventions
• Enquire about mental health history
• Refer for chosen intervention
• Identify coping strategies used in relation
• If self-referral, provide clear information about how to access
to past adverse life events
intervention
• Provide contact details for local and
• Review case regularly
national support organisations
• Provide information about the emotional
effects of cancer and relevant coping Local Psychological Support Teams
strategies • Receive referrals from disease specific MDTs, GPs and other
• If required, refer for specialist qualified individuals involved in cancer pathways
psychological assessment • Results of specialist assessment to be available
• All are responsible for communication to ensure continuity of
care and avoid duplication
General Sources of Support
The widest range of sources should be • Keep a record of suggested interventions and information
considered: provided
• Information Services
• Spiritual care (Chaplaincy) Psychological interventions
• Social care (Social Worker) • Counselling (cancer services/primary care/third sector)
• Benefits advice • Referral to psychological/psychiatric services:
• Support/self-help groups o Psychological therapy
• Befriending schemes, volunteer supporters o Anxiety management
• Complementary therapies o Acceptance and Commitment therapy
• Creative opportunities o Cognitive behavioural therapy
• Carer support services • Guided self-help/information prescriptions

Psychological Therapies and Support Framework - April 2022 20

Appendix 2: Psychological support referrals guide and case studies

Psychological Therapies and Support Framework – April 2022 21

 Criteria Assessment Intervention

Level 1: All those working in cancer care (1A) and all clinically registered staff
working in cancer care (1B)

• Mild or recent worry/anxiety to Informal/ • Effective information giving

cancer Conversational • Compassionate
• Need for information to communication
empower, enhance Recognition of
psychological • General psychological and
understanding and participate in
key discussions about how their need emotional support
cancer is managed and impacts • Effective listening
life • Peer to peer support
• General group support
• Complementary therapies
• Feel good workshops
• Signposting to levels 2, 3
or 4 as required
Level 2: All those working in cancer care with additional expertise in psychological
support
• Moderate, or mild and longer Screening for • Active listening
term, worry/anxiety related to psychological • Emotional support
cancer distress, e.g.
• Facilitated group support
• Symptomatic i.e. pain, fatigue needs
• Stress management and
• Worsening quality of life assessment,
• Mild adjustment difficulties PHQ4 problem solving
• Skilled intervention i.e.,
mindfulness based stress
reduction course
• Relaxation techniques
• Specialist information
giving and fist-line
psychological support for
immediate cancer related
distress
Level 3: Trained and accredited psychological therapists
Level 4: Counselling or clinical psychologist/psychiatrist*
Patients should be referred for Level 3: Trained and accredited psychological
additional psychological intervention therapists
(i.e., level 3 or 4 support) if the
following criteria are present: Evaluation of • Counselling and specific
psychological psychological interventions
distress – semi-
Significant problems of mood: structured
interview

Psychological Therapies and Support Framework – April 2022 22

 • Depression Level 4: Counselling or Clinical Psychologists
• Anxiety +/- panic or Psychiatrists
• Anger
• Hopelessness Clinical interview; • Specialist psychological/
• Suicidal ideation consideration of psychiatric intervention
Treatment related difficulties: diagnosis of
severe distress or
• Claustrophobia, procedural- psychopathology;
related distress, conditioned
nausea or vomiting formulation of
• Personality change as a result problem
of CNS tumour
• Requires assistance to make
treatment decisions
• Coping with fatigue and/or pain
(for which medical interventions
have been exhausted)
• Emotional distress that
prevents/hinders engagement
with medical treatment
• Feeling overwhelmed with
demands of treatment and
home/family life
Life after cancer / rehabilitation
issues
• Adjustment to loss and change
in life roles and aspirations
• Difficulty re-engaging with
aspects of life post-treatment,
e.g., employment, social life,
relationships
• Coping with effect of cancer on
self-esteem and sense of self
• Adjustment to loss and change
in physical functioning or
appearance
• Living with uncertainty (e.g.,
persistent intrusive worry/
imagery, particularly associated
with cancer recurrence)
• Adjustment to loss and change
in sexual functioning and
intimacy
End of life issues
• Facing one’s mortality
• Making decisions to end active
treatment

Psychological Therapies and Support Framework – April 2022 23

* Asking the following questions can help pre-determine if a case is level 3 or level 4 and
which pathway a referral should be made. If you answer ‘yes’ to at least one of these
questions, then consider referral to a level 4 service:

• Does the patient have previous mental health history?

• Has the patient had other stressful life events in recent past, e.g., bereavements,
significant relationship breakdown, accidents to self or other family member etc.?
• Is the patient significantly hopeless or suicidal? Is the patient self-harming?
• Are presenting problems of a complexity that will require significant multi-disciplinary
liaison?
• Is there any evidence of trauma like symptoms, e.g., thoughts and/or images related to
cancer that are uncontrollable and overwhelming?
• Is the person motivated to work collaboratively with a psychological therapist to address
difficulties?

Referrals to a level 4 service can usually only be made by an appropriately trained/qualified

individual.

If you think you require a level 4 service, in the first instance it would be helpful to
speak to someone in your care team to discuss onward referral.

Psychological Therapies and Support Framework – April 2022 24

1. Umar
Umar, 67, is married and a parent to three grown up children. Umar was diagnosed with
lung cancer after presenting with a persistent cough and unexplained weight loss.

Level 1 – All those working in cancer care

Umar is upset by the recent diagnosis and is trying to stay strong. Umar has always been
at the head of the family and is therefore worried about what the diagnosis will mean for
them. Umar doesn’t know what lies ahead but is hopeful about treatment and has been
told surgery should be an option.
Assessment Intervention
Informal / conversational Effective information giving, including information about
local community support services for both Umar and wider
family members, and how to be an active participant in
decisions and treatment. Compassionate communication
and general psychological and emotional support;
‘normalising’ Umar’s experience in this context.

Level 2 – All those working in cancer care with additional expertise

Following surgery Umar has a course of chemotherapy. Umar worries about the future
despite a positive prognosis and worries about their partner who has been supportive
throughout. They both try not to dwell on the cancer and to keep a positive mind-set, but
both are having difficulty sleeping and Umar has been quite tearful.
Assessment Intervention
Joint needs assessment As above with relaxation techniques, facilitated support
and conversation group and a fitness class for people affected by cancer.

Level 3 – Trained and accredited psychological therapists

Umar has found it difficult to cope with other underlying conditions which seem to have
worsened since being diagnosed. This is impacting upon time with the children and
grandchildren is hard. Umar feels tired, weak and irritable, and sees an old, frail person
when looking in the mirror. Umar is fearful of becoming a burden on family and is trying to
overcome all the setbacks, but is feeling overwhelmed and useless, perceiving decline as
inevitable.
Assessment Intervention
Evaluation of As above with counselling to help Umar make sense of and
psychological distress – process experiences, psychoeducation and cognitive
semi-structured interview restructuring.
Working alongside other members of the MDT to deal with
the physical consequences of treatment and to support
engagement in rehabilitation

Level 4 – Counselling or Clinical Psychologists or Psychiatrists

Umar feels hopeless and useless. Umar has become withdrawn and spends the majority
of time in bed contemplating, ‘trying not to be a burden on the family’. Umar is barely
eating and has become weak, sleeping throughout the day and night and refusing to
speak to friends or relatives. Umar’s partner is struggling to manage all of the household
tasks and work while being deeply concerned about Umar’s mood and physical health.
Umar’s partner doesn’t want to worry the children so tries to hide what is happening and
conceal feelings.

Psychological Therapies and Support Framework – April 2022 25

 Assessment Intervention
Clinical interview; Acceptance and Commitment Therapy to help Umar
consideration of diagnosis makes sense of low mood, anxiety and distress, to adjust
of severe distress or and make behaviour changes that help Umar live as fully
psychopathology; as possible with changes resulting from cancer. Joint
formulation of problem. sessions with Umar’s partner, using systemic therapeutic
interventions driven by formulation.

2. Jane
Jane, 42, is married and has two children. Jane has been diagnosed with breast cancer
which is being treated with a lumpectomy, chemotherapy and radiotherapy.

Level 1 – All those working in cancer care

Jane’s prognosis is hopeful but still uncertain. Jane is approaching the end of
chemotherapy and has been off work for six months. Jane is fatigued and feels a bit flat
and listless. Jane thinks about their cancer a lot and feels unusually irritable around
family.
Assessment Intervention
Informal / conversational Effective information giving, compassionate communication
and general psychological and emotional support;
‘normalising’ experience in this context.

Level 2 – All those working in cancer care with additional expertise

In addition to the above, Jane does not want to see people often. Jane frequently
expresses worry about the future and about bodily symptoms, which are aggravated by
uncomfortable side-effects from chemotherapy and radiotherapy. There are times when
Jane can feel enjoyment but also experiences some anxiety and low mood. Jane claims
to be coping.
Assessment Intervention
Needs assessment As above with additional behavioural activation and
relaxation techniques.

Level 3 – Trained and accredited psychological therapists

Jane has been feeling low for several months. Jane feels tired and achy, overwhelmed
with household tasks and worries that they are not able to be a good parent, becoming a
burden on family. Jane is convinced that the cancer will return. Janes feels disconnected
to who they were before, feels disfigured and unattractive and is worried about drifting
apart from their partner. Jane has begun dreading the return to work and has lost
confidence. For the first time Jane had a panic attack when due to go out last week.
Assessment Intervention
Evaluation of As above. Also cognitive behavioural therapy to help Jane
psychological distress – process experiences, psychoeducation for anxiety and
semi-structured interview cognitive restructuring for problems such as poor body
image and fear of cancer recurrence. Joined group
programme for Fear of Recurrence delivered by local cancer
charity.

Psychological Therapies and Support Framework – April 2022 26

 Level 4 – Counselling or Clinical Psychologists or Psychiatrists
Jane feels hopeless and depressed and has thoughts of ‘just ending it all’. This frightens
Jane as it’s a reminder of the nervous breakdown experienced five years ago when a
parent died of breast cancer. Jane is convinced that breast cancer will be ‘inherited’ by
the children and feels devastatingly guilty about this. Meanwhile a biopsy has shown
tumour spread and eventually Jane had to have a mastectomy. Jane now feels like an
‘ugly freak’, and this evokes feelings about the anorexia nervosa which was first
experienced as a teenager. Jane’s partner is frustrated with the withdrawal and, is feeling
angry and helpless. They have started spending more time away from home. Jane’s
partner’s work is suffering and that increases Jane’s fears about finances. One child also
seems more withdrawn, and the other has been getting into a lot of trouble at school.
Assessment Intervention
Clinical interview; Specialist psychological intervention using Compassion
consideration of diagnosis Focussed Therapy and Acceptance and Commitment
of severe distress or Therapy based on formulation and addressing Jane‘s past
psychopathology; mental health challenges as well as their current
formulation of problem depressed mood. Liaison with adult mental health to
(including full assessment facilitate changes in medication and awareness of risk of
of suicidal ideation). self-harm.

3. Taylor
Taylor, 58, was diagnosed with bowel cancer. Taylor has been in a relationship for 30 years
and is a self-employed freelance consultant. Their partner is a teacher. Taylor has had
surgery and now has a temporary stoma which will be reversed in 12 months’ time. The
stoma is well-functioning and Taylor rarely has any problems with it.

Level 1 – All those working in cancer care

Taylor’s prognosis is good. They are currently unable to work but looking forward to
returning in the next few weeks. Taylor thinks about cancer recurrence regularly but is
able to take their mind of it by keeping busy throughout the day. At night this is more
challenging, meaning it can take a while to get to sleep.
Assessment Intervention
Informal / conversational Effective information giving, compassionate communication
and general psychological and emotional support;
‘normalising’ Taylor’s experience in this context.

Level 2 – All those working in cancer care with additional expertise

Since being diagnosed and having surgery, Taylor is developing a sleep problem, waking
up at night, lying awake for an hour or so with frequent thoughts about the cancer and its
impact on life. Taylor is struggling to return to the gym as they are feeling self-conscious
about the stoma and worried it will leak. Taylor is also starting to feel nervous about
returning to work so is trying to stay positive by thinking ahead to holidays. However,
affordable insurance is proving challenging and this is getting Taylor down.
Assessment Intervention
Needs assessment As above with additional behavioural activation and
relaxation techniques.

Psychological Therapies and Support Framework – April 2022 27

 Level 3 – Trained and accredited psychological therapists
Taylor is developing a pattern of avoiding going out anywhere: they no longer meet up
with friends in the pub, won’t exercise, and won’t go out with their partner anymore due to
concerns about the stoma leaking. Taylor feels low much of the time and is noticing more
time is spent ruminating about how cancer has ruined their life. Taylor is feeling less
hopeful about a return to work and is concerned about finances and the future. Taylor is
also becoming less tolerant and seems to be arguing more with their partner.
Assessment Intervention
Evaluation of As above. Therapy to address Taylor’s worries and
psychological distress – concerns; may be person-centred or CBT. Joins 8 week
semi-structured interview mindfulness programme delivered through third sector.

Level 4 – Counselling or Clinical Psychologists or Psychiatrists

In addition to the above, Taylor is only sleeping about two hours a night, feeling
significantly low in mood and overwhelmingly hopeless. Taylor is seeing parallels with
how they felt ten years ago when they were made redundant. Taylor has started to sleep
in a separate bedroom as they believes the stoma is disgusting and does not wish for
their partner to see it. The couple argue frequently, their sex life is non-existent, and
Taylor feels a lack of understanding from their partner about how much cancer has ruined
their life. Taylor hasn’t left the house in four weeks, other than for medical appointments.
Taylor refuses to speak with friends on the ‘phone and will not allow any family or friends
to visit.
Assessment Intervention
Clinical interview; Specialist psychological intervention based on formulation
consideration of diagnosis including CBT for insomnia, Acceptance and Commitment
of severe distress or Therapy and systemic therapy with Taylor’s partner to
psychopathology; support them with relationship difficulties.
formulation of problem.

Psychological Therapies and Support Framework – April 2022 28

Appendix 3: Education and training grid
The grid below details the knowledge and competencies required across each staff
level, alongside example interventions utilised by each group. Core training tools
recommended for different staff groups according to the level of training and experience
in psychological practice are noted. These are Informed (level 1), Skilled (level 2),
Enhanced (level 3) and Specialist (level 4). A detailed overview of training tools is
provided. The grid provides examples of training which is available and does not
represent an exhaustive list.

The core training tools included have been mapped against the core competencies
outlined within ‘A Competence Framework for Psychological Interventions with People
with Persistent Physical Health Problems’ which was launched in Scotland in March
2016. This competence framework was commissioned by NHS Education for Scotland
and the Improving Access to Psychological Therapies (IAPT) programme in England
(Psychological Interventions with People with Persistent Physical Health Problems).

Please note: Training tools / interventions listed in levels 1 and 2 are still relevant
across higher levels.

You must be signed in to Turas to access the links below.

Please note Turas is open to NHS and non-NHS staff – if you do not have an account
you can request one via the Turas helpdesk.

Psychological Therapies and Support Framework – April 2022 29

Core competencies Interventions Training

(1A) Informed– All those working in cancer care

• Understand concept of distress and • Effective information Emotion Matters

the importance of recognising giving
psychological needs • Establishing rapport Additional training tools
• Basic awareness of the range of and maintaining (where specific
specific psychological problems supportive requirement of role)
(e.g. anxiety and depression) relationships
• Basic listening and communication
• Compassionate
skills
communication
• Ability to recognise psychological
needs • Avoid causing
psychological harm
• Ability to offer general support and
to communicate honestly and
compassionately
• Treat patients and supporters with
kindness, dignity and respect
• Knowledge and understanding of
prehabilitation as part of the
prehab- rehab continuum
• Knowledge of when and how to
refer on to senior colleagues or
appropriate agencies
• Knowledge of the range of
emotional and support services
available
(1B) Informed – All clinically registered staff working in cancer care

• Knowledge or experience in • Within defined role Shared decision making

working with psychological issues undertake needs
experienced by people with Additional training tools
assessment, and
cancer/palliative care needs (where specific
signpost to support
• Knowledge and competency in the requirement of role)
services or specialist
use of assessment tools as
appropriate psychological Mental health
• Recognise boundaries of own support as improvement, and
professional responsibility and necessary prevention of self-harm
competence and to refer on as • Shared decision and suicide
appropriate making
• Awareness of the impact of Foundation level
• Patient centred
previous trauma on ability to communication skills
discussion of health
engage with healthcare (Rapport, SAGE &
behaviour change THYME)
• Knowledge of how to encourage
engagement and collaboration in PRosPer
(prehabilitation,
health related decisions and rehabilitation and
behaviours, including prehabilitation

Psychological Therapies and Support Framework – April 2022 30

• Ability to support people with personalised care –
procedural anxiety basic level)
Bereavement training

National trauma training

programmes - Informed
Level e.g., Opening Doors

Psychological Therapies and Support Framework – April 2022 31

(2) Skilled– All those working in cancer care with additional expertise in psychological support

• Knowledge or experience in • Undertake needs Developing Practice or

working with psychological issues assessment and risk similar i.e. (SWAG) Cancer
experienced by people with stratification Alliance 2019 Level 2
cancer/palliative care needs • Refer on for Psychological Skills
• Knowledge of psychological specialist Training for Oncology and
processes of adjustment and loss psychological Palliative Care Staff
• Knowledge and ability to support as
Advanced clinical
communicate ‘bad news’, and/or necessary
communication skills (this
offer supportive interventions at this • Psychological
may be available locally
time techniques such as
via your clinical psychology
• Knowledge and competency in the problem solving
team)
use of assessment tools as
appropriate Additional training tools
• Elicit worries and concerns by (where specific
establishing trust and listening in a requirement of role)
permissive and non-judgemental
manner MAP Health behaviour
change
• Ability to effectively encourage
health behaviour change, including Motivational interviewing
engagement with prehab, using
motivational interviewing ASSET (Astley Ainslie
techniques Psychological Skills and
• Ability to enhance patients’ and Education Training)
carers’ capacity to cope and meet
Suicide prevention –
their own needs for support, making
Skilled, or locally/privately
use of family, friends, self-help and
provided training i.e.,
support groups
STORM
• Offer appropriate psycho-
educational and problem-solving Cancer related cognitive
techniques impairment
• Ability to access and use
PRosPer (prehabilitation,
appropriate case work supervision
rehabilitation and
and training
personalised care –
• Recognise boundaries of own
general level)
professional responsibility and
competence and to refer on as National trauma training
appropriate. programmes - Skilled level

Psychological Therapies and Support Framework – April 2022 32

(3) Enhanced – Trained and accredited psychological therapists

• Knowledge and critical • Assess for Appropriate professional

understanding of the evidence- psychological qualification
based rationale for the use of distress and
diagnose some CPD in line with
specified therapies
psychopathology professional regulatory
• Knowledge of psychological theory • Counselling and body
and models that are most relevant specific
to cancer & palliative care, psychological Additional training tools
including advanced knowledge of interventions (where specific
the nature of adjustment and loss delivered according requirement of role)
• Knowledge of professional to a specific
guidelines and local and national Further training in specific
theoretical
policies to ensure high standards of models of counselling /
framework
service delivery psychological interventions
• Expertise in a specific e.g., ACT, CBT,
psychotherapeutic model, and mindfulness, person
experience of applying their skills centred counselling.
with individuals, families and Oncology specific
groups appropriate to their level of induction, e.g. anatomy
training and oncology for non-
• Ability to provide supervision, clinicians, CBT for people
support and education about with cancer.
psychological issues and
interventions PRosPer (prehabilitation,
• Ability to promote high quality rehabilitation and
psychological care by providing personalised care –
consultation to and working with advanced level)
members of the multidisciplinary
Safety and Stabilisation for
team
Clinical Health

Suicide prevention -
Enhanced

(4) Specialist – Counselling or clinical psychologist/psychiatrist

• Specialist knowledge and • Assess complex Appropriate doctoral level

experience of assessing and psychological professional qualification
intervening with complex and problems
severe mental health problems • Specialist CPD in line with
psychological and professional regulatory
• Specialist knowledge of, and psychiatric body
expertise in, a range of interventions for
psychological therapies appropriate managing moderate AsSET Train the Trainer

Psychological Therapies and Support Framework – April 2022 33

 to the needs of people with life to severe mental Developing Practice Train
threatening illness and their health problems the Trainer
supporters. This includes detailed
knowledge of the care of people
with mental health needs, and/or of Additional training tools
the use of psychotropic medication. (where specific
• An ability to undertake a requirement of role)
comprehensive psychological risk
assessment taking into account Further training in specific
relevant social, familial and cultural models of psychological
• An ability to use clinical experience intervention
and judgement, objective testing
and access appropriate medical Oncology specific
and mental health history in order induction, e.g., Anatomy
to identify presenting mental and oncology for non-
health/psychological problems and clinicians, CBT for people
develop a meaningful formulation with cancer
which guides evidence-based
interventions PRosPer (prehabilitation,
• Skills to provide organisational rehabilitation and
leadership for specialist personalised care –
psychological services advanced level)
• Ability to act as a specialist
resource to local cancer and
palliative care services by providing
expertise in consultation, education,
supervision and research
• An ability to work and liaise at an
organisational and strategic level to
promote the provision of high
• standards of psychological care

Please note: Given the different skill set required for treating patients under 25 years of age
a specific Paediatric Training Portfolio is available from the NHS Education for Scotland
website.

Psychological Therapies and Support Framework – April 2022 34

Appendix 4: Quality statements self-assessment template
The following self-assessment template should be completed to detail your organisations
position against the agreed quality statements.

Organisation Submission completed Job Title

by (name)

Date submission Data period covered PTSF Steering Group

completed Representative

Organisation Submission completed Job Title

by (name)

Clinical Quality Statement 1

People affected by cancer should have ready access to the appropriate level of
evidence based psychological intervention to meet their needs at all parts of their
treatment pathway.

Position Statement Level 1 Level 2 Level 3 Level 4

Details of what services are

provided at each level

No. of patients seen by service

at each level

Treatment stage

Waiting time per level of service

provision

(days/weeks)

Action update on Statement Progress / Barriers Timescale

Actions from previous year

Planned actions for the coming

year

Psychological Therapies and Support Framework – April 2022 35

 Clinical Quality Statement 2

Recognised and agreed screening and assessment tools, should be used to

ensure an appropriate, individualised plan for meeting the identified needs of
people affected by cancer is agreed.

Position Statement Level 1 Level 2 Level 3 Level 4

Recognised and agreed

screening and assessment
tools, should be used to ensure
an appropriate, individualised
plan for meeting the identified
needs of people affected by
cancer is agreed.

Recognised and agreed

screening and assessment
tools, should be used to ensure
an appropriate, individualised
plan for meeting the identified
needs of people affected by
cancer is agreed.

Action update on Statement Progress / Barriers Timescale

Actions from previous year

Planned actions for the coming

year

Clinical Quality Statement 3

People affected by cancer receiving a psychological intervention should have their

response to treatment monitored and the delivery of treatment adjusted in
response to outcomes.
Position Statement Level 1 Level 2 Level 3 Level 4

Description of outcome
monitoring process in place

Action update on Statement Progress / Barriers Timescale

Psychological Therapies and Support Framework – April 2022 36

 Actions from previous year

Planned actions for the coming

year

Service Quality Statement 1

Services should have a clearly defined pathway detailing the provision of

psychological assessment and care for people affected by cancer, including clear
referral processes and good accessibility for referrers and service users.

Position Statement Level 1 Level 2 Level 3 Level 4

Location and scope of service

information available including
where potential referrers can
find details of accessibility of
services, referral criteria and
relevant contact details.

Referral routes including details

of who can refer to each level of
service and referral information
required.

Feedback mechanism for

outcome of referral

Details of current referral

sources

Action update on Statement Progress / Barriers Timescale

Actions from previous year

Planned actions for the coming

year

Service Quality Statement 2

Psychological Therapies and Support Framework – April 2022 37

 All individuals working within relevant services should complete appropriate
training to ensure their knowledge and skills are appropriate for the level of
psychological care provided.

Position Statement Level 1 Level 2 Level 3 Level 4

Has the Training Matrix been Yes / No Yes / No Yes / No Yes / No

used to determine the training
needs of staff/volunteers?

Number of staff working at each

level?

No. of volunteers working at

each level?

No. of staff/volunteers
undertaken training at this level?
Please specify what training e.g.
Emotion Matters for Level 1?

Training access issues/

opportunities?

Action update on Statement Progress / Barriers Timescale

Actions from previous year

Planned actions for the coming

year

Service Quality Statement 3

All professionals delivering psychological interventions should have regular and

routine access to consultation and/or supervision to optimise competency and
delivery of interventions.

Position Statement Level 1 Level 2 Level 3 Level 4

Psychological Therapies and Support Framework – April 2022 38

 Description of current process
regarding supervision of staff
and volunteers at each level.

Action update on Statement Progress / Barriers Timescale

Actions from previous year

Planned actions for the coming

year

Psychological Therapies and Support Framework – April 2022 39

Appendix 5: Psychological therapies and support framework working
group membership
Name Title Representing

Gillian Hailstones Co-Chair, Director of Care Beatson Cancer Charity

Services
West of Scotland
Psychological Care and
Support Steering Group)

Helen Moffat Co-Chair, Consultant NHS Grampian

Clinical Psychologist for
Oncology and Palliative
Care

Lesley Howells Lead Psychologist Maggie’s

Seona Carnegie Secretariat, Policy Manager Scottish Government

Debbie Provan Clinical Advisor Scottish Government

Rob Murray Chief Executive Scottish Cancer Coalition

Cancer Support Scotland

Sara MacLennan University of Aberdeen

UCAN (Urological Cancer

Charity)

Claire Alexander Partnership Assurance Lead Macmillan Cancer Support

Amy Anderson Prehabilitation Project Lead North Cancer Alliance

Kirsty Whiteside Improving the Cancer

Journey (National
Representative)

Jinette Mathieson Macmillan Cancer Nurse NHS Grampian

Consultant/ CNS Strategic
Lead Scottish Cancer Lead
Nurses/ Nurse Consultant
Group

Psychological Therapies and Support Framework – April 2022 40

Original WoSCAN Group Membership

Name Title Representing

Madaline Alexander Service Manager Cancer Support Scotland

Jane Beresford Public Health Programme NHS Greater Glasgow and
Manager Clyde
Iain Campbell Clinical Psychologist NHS Forth Valley
Kerry Craig Centre Head Maggie’s
Rosalie Dunn Primary Care Cancer Primary Care Cancer
Network Lead Clinician Network
Gillian Hailstones Operations Manager Maggie’s
Angela Harris Scotland Service Breast Cancer Care
Development Manager
Chris Hewitt Clinical Psychologist NHS Greater Glasgow and
Clyde
Nici Hill-Lyons West of Scotland Macmillan Cancer Support
Development Officer
Sandra McCall Chief Executive Ayrshire Cancer Support
Emily McIntosh Clinical Psychologist NHS Lanarkshire
Kathleen McHugh Clinical Psychologist NHS Greater Glasgow and
Clyde
Esther Murray Clinical Psychologist NHS Ayrshire and Arran
Susie Porteous Clinical Psychologist NHS Forth Valley
Iona Scott Quality & Service WoSCAN
Improvement Manager
Grace Stewart Head of Services Beatson Cancer Charity
Lorraine Webster Macmillan Support Beatson West of Scotland
Radiographer Cancer Centre
Nic White Head of Scotland Breast Cancer Care
Sandra White TCAT Clinical Lead WoSCAN
Janice Williams Manager The Haven, Lanarkshire

Wider Consultation

Name Title Representing

Jo Anderson Director of External Affairs Scottish Association for

Mental Health

Psychological Therapies and Support Framework – April 2022 41

 Philip Hacking Healthcare Chaplain NHS Forth Valley
Fiona McMahon Improvement Advisor, NHS Greater Glasgow and
Psychological Therapy Clyde
West of Scotland
Consultant Nurse Group

Additional contributions were made by a wide variety of individuals and organisations as

part of the Psychological Therapies and Support Framework Implementation Steering
Group and Subgroups, including the Pathways and Patterns Subgroup, the Data Subgroup
and the Education and Training Subgroup.

Psychological Therapies and Support Framework – April 2022 42