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Journal of Psycho-Oncology; Supporting cancer patients with mindfulness-based CBT

We are excited to share with you that members of the Community of Practice from the Clinical Psychology Cancer Service Team at Sherwood Forest Hospital Foundation Trust, have recently published their proof of concept evaluation of using Flo to support cancer patients undertaking mindfulness-based CBT in the open-access Psycho-Oncology journal.   In addition to the work being published, the cancer support pathway was also shortlisted as a finalist for this years’ HSJ Awards, and has received a commendation in the category for mental health innovation at the Health Business Awards 2019.

A relatively new service, the Clinical Psychology Cancer Service was set up in 2014 to provide support to adults affected by cancer and were recently awarded a Macmillan Professionals Excellence Award for Integration Excellence.  Despite the team having high levels of clinical effectiveness, the drop out rates for psychological therapies were found to be quite high, especially amongst cancer patients, who have three times the risk of developing depression and anxiety.

Dr Sam Malins and the Clinical Psychology Cancer Service Team were looking for a low-cost digital solution to develop a blended approach of face to face and remote therapy sessions, with supportive messaging between clinical contacts.  In collaboration with Nottinghamshire University, their local Florence administration team and some additional support from Simple Shared Healthcare, the team developed pathways with Flo to reduce drop-out rates, encourage ongoing engagement throughout the course of treatment to achieve better mental health outcomes and improve relapse prevention.

The resulting protocols are unique & innovative with some of the responses Flo sends being fully personalised, written collaboratively by the patient and their healthcare professional. During treatment, patients receive additional support and advice between their scheduled appointments, alongside messages to reinforce learning from their most recent sessions. Whilst under the care of the team and also beyond discharge, patients are also regularly prompted to return a wellbeing score, to which they receive their personalised messages based on the work completed with their clinician.

Integration of Flo into the pathway has had some fantastic results, including:

  • Patients supported by Flo were eight times more likely to complete their treatment programme when compared to those not supported by Flo
  • Patients supported by Flo also reported a greater improvement in depression over the course of the programme.
  • Interviews with patients suggested that they found Flo’s messages to be motivating reminders to practice techniques, and also acted as a personal connection.

Patients comments included:

I thought they were good, [Flo] sort of motivated you and was a gentle reminder really…. I thought that that was a good idea

If you found yourself getting lost they were good reminders to put you back on track

When you got it you felt “oh somebody is thinking about me.” Even though it was just a text message

You felt like – I mean, I know they [Flo’s messages] were automated, but in a silly way it felt like somebody was motivating you. I enjoyed them actually.” 

Florence seems to text me exactly when I need it the most. Always helps me. Overall amazing” 

From the clinician’s perspective, implementing Flo has a number of benefits such as:

  • Prevention of re-referral.
  • Increased therapeutic capacity, with more patients successfully treated in each group.
  • Simple & easy for clinicians to implement with a low input and time cost.

The full journal article is open-access and available here, or if you would like to learn more about the pathway and the team’s journey, you can contact Sam at

We are delighted that Simple Shared Healthcare have been able to support the open access publication to expand the reach of the team’s fantastic work.  As a Community of Practice, we are always looking for great examples of where Flo has made a real difference to patients and clinical practice.  If you are considering publishing your findings with Flo and would like to know more about how we may be able to support you with this, please do get in touch with a member of the team:

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