Do cancer patients experience less psychological distress with a brief psychological intervention package compared to routine clinical care?

Study setting : A room adjoining the surgical clinic CSTH . Randomization method: The allocation ratio into two arms would be 1:1. Computer-generated random numbers will be used in randomization. Intervention : Control arm Recruitment will be done after one week of breaking bad news at special clinic for cancer patients . 1.Routine care by surgical house officers ,senior registrar is as follow: Explain patients about the surgery, prepare them by doing pre-operative investigations. Referrals to care teams example cardiologist, anaesthetist. Arrange a date for surgery. If patient is refusing his surgery or express depressive symptoms refer to psychiatric care. If patient is not having capacity to consent assessment of capacity to consent by a psychiatrist. No counselling, discussion about their distress is included in routine care. SCREENING AT BASE LINE Eligible patients are assessed using HADS scale (hospital depression anxiety score) after one week of breaking bad news. If they are having high scores 11-21 or severe symptoms which needs psychiatric drugs or psychotherapy, remove from study. Reassessment Week 3 from the baseline Reassessment is done with HADS scale and questionnaire 2.Intervention group BASELINE Eligible patients will be assessed with HADS score if more than 6 will be recruited. If very high scores 11-21 will refer to psychiatric care and if treatment or different psychotherapy is offered they will be removed from the study. Intervention: Session one - First session of the intervention will be done on the day of recruitment, after the baseline assessment. Duration is 2 hours. It is done by a surgical senior registrar and a psychiatrist. 1.Education on cancer: carried out by Senior Registrar in surgery -30 minutes 2.Relaxation training on managing stress response: 30 minute by consultant psychiatrist 3.Problem solving counselling – 1 hour by a Consultant Psychiatrist - a counselling session Session two This will be done after I week from the first session. Duration is two hours . This will be done by the same team and discussion is based on same topics. Post intervention assessment - This will be done three weeks from baseline using HADS and the same questionnaire used in baseline assessment.

1. Patients with new/ recent histopathological diagnosis /radiological diagnosis of a malignant lesion of any site
2. Age between 18-65 years
3. Both male and female patients 4.Cancer stage which is eligible for surgery as determined by investigation procedures and clinical judgment
   
4. Patients who are having HADS score more than > 6 will be recruited to the study

1. Patients with already diagnosed psychiatric disorders (with a diagnosis of any one or more conditions specified under F00-F99 under ICD diagnosis research version (‘The ICD-10’, no date).
2. Patients with severe physical suffering and who are unwell to communicate or travel.
3. Patients who are diagnosed/carrying a card or past records with a severe learning disability, organic brain dysfunction due to cerebral deposits, diagnosed patients with dementia will not be recruited to the study) the research assistants will be trained for this using ICD diagnostic criteria for the research version.
4. Patients who are participating in other interventional studies.
5. Patients who are coming more than one week after breaking bad news.
6. Patients who are having HADS SCORE less than 6