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Savioni L, Triberti S, Durosini I, Sebri V, Pravettoni G. Cancer patients' participation and commitment to psychological interventions: a scoping review. Psychol Health 2021; 37:1022-1055. [PMID: 33966548 DOI: 10.1080/08870446.2021.1916494] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Some psychological interventions have been developed to improve cancer patients' and survivors' quality of life, well-being, and health engagement. However, studies are usually focused on effectiveness and less on factors influencing survivors' decision to participate, both subjective (e.g., needs) and contingent (e.g., factors related to participation/non participation). This scoping review identifies factors influencing participation, decline to participate, attrition and adherence in psychological interventions. METHODS 3 electronic databases were searched for published studies on psychological interventions. Retrieved publications were scanned by authors against inclusion criteria and forty-two articles were selected. Relevant information were summarized narratively. RESULTS More information is available on attrition and factors related to participation/non participation, so that future psychological interventions may employ ad-hoc tools to take into consideration patients' reasons to adhere to psychological interventions. Secondarily, non-participation/dropout is often linked to factors related to intervention' commitment and its interference with daily life. On the contrary, patients' reasons to participate often identify with the value they find in the intervention according to their personal needs and experience of illness. CONCLUSION We suggest that future research should analyze patients' representation of psychological interventions and take them into account to tailor the interventions on participants' lived experience, to improve participation.
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Affiliation(s)
- Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Triberti
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Sebri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
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Lilliehorn S, Isaksson J, Salander P. What does an oncology social worker deal with in patient consultations? - An empirical study. SOCIAL WORK IN HEALTH CARE 2019; 58:494-508. [PMID: 30901286 DOI: 10.1080/00981389.2019.1587661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/16/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
The oncology social worker is a core profession in the psychosocial care of cancer patients, and has been scrutinised according to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker's (OSW's) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients displayed a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the 'carrying on as before' or finding a 'new normal'. The paper discusses the importance of the OSW being acquainted with different counseling/psychotherapy perspectives in the illness context, but primarily the importance of having the ability to establish a 'working alliance' with their patients.
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Affiliation(s)
- Sara Lilliehorn
- a Department of Social Work , Umeå University , Umeå , Sweden
- b Department of Radiation Sciences - Oncology , Umeå University , Umeå , Sweden
| | - Joakim Isaksson
- c Department of Social Work , Stockholm University , Stockholm , Sweden
| | - Pär Salander
- a Department of Social Work , Umeå University , Umeå , Sweden
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Ehlers SL, Davis K, Bluethmann SM, Quintiliani LM, Kendall J, Ratwani RM, Diefenbach MA, Graves KD. Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship. Transl Behav Med 2019; 9:282-291. [PMID: 30566662 PMCID: PMC6610173 DOI: 10.1093/tbm/iby123] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Accreditation standards are at the forefront of evolving healthcare systems, setting metrics for high-quality care. Healthcare outcomes (health, experience, cost, provider satisfaction/burn out) are becoming mutual goals of the patient, provider, payer, and healthcare system. Achieving high-quality outcomes in cancer care necessitates collaboration among interdisciplinary teams of clinical providers, administrators, patient advocates, caregivers, and researchers. Dissemination and implementation science provides necessary frameworks to organize the efforts of these implementation teams, inclusive of identifying facilitators and barriers to implementation of accreditation standards. Since 2015, cancer distress screening has been mandated for continued cancer center accreditation by the American College of Surgeon's Commission on Cancer. Cancer centers have thus become real world implementation laboratories. We present the current context of distress screening, highlighting prior research and key areas of future research. We consider multiple levels of cancer care delivery and the use of interdisciplinary teams to help cancer center teams adopt, implement, and maintain efficient distress screening programs. Finally, we present a case study to identify methods for successful implementation of distress screening at one cancer center and then describe efficiencies that can be introduced using elements from human factors engineering, e- and m-health screening platforms, and community partnerships.
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Affiliation(s)
- Shawna L Ehlers
- Department of Psychiatry and Psychology, Mayo College of Medicine and Science, Rochester, MN, USA
| | - Kimberly Davis
- Departments of Oncology and Psychiatry, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shirley M Bluethmann
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Lisa M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, MA, USA
| | - Jeffrey Kendall
- Oncology Service Line, University of Minnesota Cancer Care, Minneapolis, MN, USA
| | - Raj M Ratwani
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA
| | - Michael A Diefenbach
- Feinstein Institute for Medical Research, Center for Health Innovation and Outcomes Research, Manhasset, NY, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Salander P. Does advocating screening for distress in cancer rest more on ideology than on science? PATIENT EDUCATION AND COUNSELING 2017; 100:858-860. [PMID: 27916462 DOI: 10.1016/j.pec.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden.
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Gnagnarella P, Misotti AM, Santoro L, Akoumianakis D, Del Campo L, De Lorenzo F, Lombardo C, Milolidakis G, Sullivan R, McVie JG. Nutritional Online Information for Cancer Patients: a Randomized Trial of an Internet Communication Plus Social Media Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:472-480. [PMID: 25820605 DOI: 10.1007/s13187-015-0820-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We hypothesized that cancer patients using an Internet website would show an improvement in the knowledge about healthy eating habits, and this might be enhanced by social media interaction. A 6-month randomized intervention was set up. Eligible subjects were allocated in intervention (IG) and control groups (CG). IG had access to the website, and CG was provided with printed versions. All enrolled participants filled in Nutrition Questionnaire (NQ), Quality of Life Questionnaire (QoL) and Psychological Distress Inventory (PDI), at baseline and after 6 months. The difference between post- vs pre-questionnaires was calculated. Seventy-four subjects (CG 39; IG 35) completed the study. There was an increase in the score after the intervention in both groups for the NQ, even if not statistically significant. Dividing the IG into three categories, no (NI), low (LI) and high interactions (HI), we found a decreased score (improvement) in the CG (-0.2) and in the HI (-1.7), and an increased score (worsening) in the NI (+3.3) (p = NS) analysing the PDI. We found an increased score in the QoL both in CG and IG (adjusted LSMeans +3.5 and +2.8 points, respectively; p = NS). This study represents an example for support cancer patients. Despite the lack of significant effects, critical points and problems encountered may be of interest to researchers and organization working in the cancer setting. Intervention strategies to support patients during the care process are needed in order to attain the full potential of patient-centred care on cancer outcomes.
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Affiliation(s)
- Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy
| | - Alessandro Maria Misotti
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy.
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ramusio 1, 20141, Milan, Italy
| | - Demosthenes Akoumianakis
- Centre for Technological Research of Crete, Technological Education Institution of Crete, Crete, Greece
| | - Laura Del Campo
- Federazione Italiana Delle Associazioni di Volontariato in Oncologia, Rome, Italy
| | - Francesco De Lorenzo
- Federazione Italiana Delle Associazioni di Volontariato in Oncologia, Rome, Italy
| | - Claudio Lombardo
- Organisation of the European Cancer Institute, Brussels, Belgium
- SOS Europe Srl, Genoa, Italy
| | - Giannis Milolidakis
- Centre for Technological Research of Crete, Technological Education Institution of Crete, Crete, Greece
| | | | - John Gordon McVie
- Scientific Directorate, European Institute of Oncology, Milan, Italy
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Funk R, Cisneros C, Williams RC, Kendall J, Hamann HA. What happens after distress screening? Patterns of supportive care service utilization among oncology patients identified through a systematic screening protocol. Support Care Cancer 2016; 24:2861-8. [PMID: 26838023 DOI: 10.1007/s00520-016-3099-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/24/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE While distress screening is important for identifying unmet needs of cancer patients, less is known about referral and uptake of supportive care services among distressed patients. The current analysis examined screen-based rates of referral to supportive care and explored demographic and clinical correlates of referral uptake. METHODS We tracked distress screens completed by a varied group of cancer patients receiving outpatient care at a National Cancer Institute (NCI)-designated cancer center during a 1-month period. Electronic medical record review was used to examine the rates of supportive care referral and uptake among distressed patients. RESULTS Out of 644 unique screens, 195 (30 %) patients reported significant distress; distressed patients were more likely to be non-white (odds ratio (OR) = 1.71, p < 0.01), prescribed psychiatric medication (OR = 1.92, p < 0.00), and have no previous contact with the cancer center's supportive care staff (OR = 1.62, p = 0.01). Thirty-four of these patients pre-emptively declined supportive care contact; thus, 161 were referred for supportive care. Among the 99 patients who received initial assessments by a team member, only 19 (19 %) requested and completed at least one follow-up appointment. CONCLUSIONS Findings from this analysis support earlier work demonstrating significant supportive care needs in cancer patients. However, it challenges the assumption that screening will result in increased uptake of supportive care services beyond initial assessment. Further work should focus on facilitating engagement and reducing barriers for patients with continuing post-assessment supportive care needs.
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Affiliation(s)
- Rachel Funk
- Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA.
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Cassidy Cisneros
- Baylor University Medical Center at Dallas, Dallas, TX, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rush C Williams
- Washington DC VA Medical Center, Washington, DC, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Kendall
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heidi A Hamann
- University of Texas Southwestern Medical Center, Dallas, TX, USA
- University of Arizona, Tucson, AZ, USA
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Clover KA, Mitchell AJ, Britton B, Carter G. Why do oncology outpatients who report emotional distress decline help? Psychooncology 2014; 24:812-8. [DOI: 10.1002/pon.3729] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/14/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Kerrie Ann Clover
- Psycho-Oncology; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
- School of Psychology; University of Newcastle; Newcastle New South Wales Australia
| | - Alex J. Mitchell
- Department of Psycho-oncology; University of Leicester and Leicestershire Partnership Trust; Leicestershire UK
| | - Ben Britton
- Psycho-Oncology; Calvary Mater Newcastle; Newcastle New South Wales Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
| | - Gregory Carter
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Newcastle New South Wales Australia
- Consultation-Liaison Psychiatry; Calvary Mater Newcastle; Newcastle New South Wales Australia
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Braeken APBM, Lechner L, Eekers DBP, Houben RMA, van Gils FCJM, Ambergen T, Kempen GIJM. Does routine psychosocial screening improve referral to psychosocial care providers and patient-radiotherapist communication? A cluster randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2013; 93:289-297. [PMID: 23992914 DOI: 10.1016/j.pec.2013.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 06/07/2013] [Accepted: 06/23/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE This study tests whether using a screening instrument improves referral to psychosocial care providers (e.g. psychologist) and facilitates patient-radiotherapist communication. METHODS A cluster randomized controlled trial was used. Fourteen radiotherapists were randomly allocated to the experimental or control group and 568 of their patients received care in accordance with the group to which their radiotherapist was allocated. Patients in the experimental group were asked to complete a screening instrument before and at the end of the radiation treatment period. All patients were requested to complete questionnaires concerning patient-physician communication after the first consultation and concerning psychosocial care 3 and 12 months post-intervention. RESULTS Patients who completed the screening instrument were referred to social workers at an earlier stage than patients who did not (P<0.01). No effects were observed for numbers of referred patients, or for improved patient-radiotherapist communication. CONCLUSIONS Our results suggest that a simple screening procedure can be valuable for the timely treatment of psychosocial problems in patients. Future efforts should be directed at appropriate timing of screening and enhancing physicians' awareness regarding the importance of identifying, discussing and treating psychosocial problems in cancer patients. PRACTICE IMPLICATIONS Psychosocial screening can be enhanced by effective radiotherapist-patient communication.
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Affiliation(s)
- Anna P B M Braeken
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands; Department of Health Services Research, CAPHRI School for Public Health and Primary, Maastricht University, Maastricht, The Netherlands.
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Clover K, Kelly P, Rogers K, Britton B, Carter GL. Predictors of desire for help in oncology outpatients reporting pain or distress. Psychooncology 2012; 22:1611-7. [DOI: 10.1002/pon.3188] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Kerrie Clover
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Pete Kelly
- University of Wollongong; Psychology; Wollongong; New South Wales; Australia
| | - Kerry Rogers
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Ben Britton
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
| | - Gregory Leigh Carter
- Calvary Mater Newcastle, Psycho-Oncology Service; Newcastle; New South Wales; Australia
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Gnagnarella P, Misotti AM, Santoro L, Akoumianakis D, Milolidakis G, De Lorenzo F, Lombardo C, Sullivan R, Mcvie G. A dedicated website for cancer subjects, the nutritional support study: preliminary results. Ecancermedicalscience 2011; 5:228. [PMID: 22276066 PMCID: PMC3251511 DOI: 10.3332/ecancer.2011.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Internet has become a widely used resource for information on cancer and for support. As part of the EuroCancerComs project (www.eurocancercoms.eu), an intervention study has been designed. The study aims to help patients with cancer providing an Internet "space" where to find information about nutritional care. METHODS The study consists of a randomized 6-month intervention. The website (www.supportonutrizionale.it) hosts a contents area, prepared according to guidelines and recommendations, a forum and a blog. Subjects have been randomly allocated in intervention (IG) and control group (CG). IG has a free access to the website and it is involved in live activities, discussions and examinations. CG receives the same information by e-mail, without having access to the website. Three questionnaires are used to evaluate the effectiveness of the approach, concerning quality of life (QoL), psychological status and nutrition facts. RESULTS Since the study startup, 191 subjects have been screened, and 58 (30%) have been randomized. Participants in both groups are mainly females, married and have at least a high school education level. Participants experienced a high psychological distress for 27% of IG and 33% of CG considering the four classes of scores at the baseline. Regarding QoL, a low "role functioning" score for IG and "emotional functioning" and "social functioning" scores for both groups are reported, while "fatigue" and "nausea and vomiting" respectively for IG and CG are the worsened symptoms compared with reference values. Considering the nutrition facts questionnaire, subjects showed a medium-high score profile and the worst scale regards "Nutrition and cancer knowledge". From the beginning of the study, a total of 48 actions have been registered, including votes to contents, comments and forum messages. CONCLUSION The Internet has made possible the new forms of interaction and knowledge, and it is likely to become essential to gain access to health information. The results of this randomized intervention may help in the evaluation of the efficacy of these interventions in cancer setting.
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Affiliation(s)
- P Gnagnarella
- Divisione di Epidemiologia e Biostatistica, Istituto Europeo di Oncologia, Milan, Italy
| | - AM Misotti
- Divisione di Epidemiologia e Biostatistica, Istituto Europeo di Oncologia, Milan, Italy
| | - L Santoro
- Divisione di Epidemiologia e Biostatistica, Istituto Europeo di Oncologia, Milan, Italy
| | - D Akoumianakis
- Center for Technological Research of Crete, Technological Education Institution of Crete, Greece
| | - G Milolidakis
- Center for Technological Research of Crete, Technological Education Institution of Crete, Greece
| | - F De Lorenzo
- Federazione Italiana delle Associazioni di Volontariato in Oncologia, Rome, Italy
| | - C Lombardo
- IRCCS Azienda Ospedaliera Universitaria San Martino – IST – Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy, Organisation of the European Cancer Institutes, Brussels
| | - R Sullivan
- Kings College London, and Project Manager of EuroCancerComs- FP7
| | - G Mcvie
- Direzione Scientifica, Istituto Europeo di Oncologia, Milan, Italy
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Braeken APBM, Kempen GIJM, Eekers D, van Gils FCJM, Houben RMA, Lechner L. The usefulness and feasibility of a screening instrument to identify psychosocial problems in patients receiving curative radiotherapy: a process evaluation. BMC Cancer 2011; 11:479. [PMID: 22067707 PMCID: PMC3247231 DOI: 10.1186/1471-2407-11-479] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 11/08/2011] [Indexed: 11/25/2022] Open
Abstract
Background Psychosocial problems in cancer patients are often unrecognized and untreated due to the low awareness of the existence of these problems or pressures of time. The awareness of the need to identify psychosocial problems in cancer patients is growing and has affected the development of screening instruments. This study explored the usefulness and feasibility of using a screening instrument (SIPP: Screening Inventory of Psychosocial Problems) to identify psychosocial problems in cancer patients receiving curative radiotherapy treatment (RT). Methods The study was conducted in a radiation oncology department in the Netherlands. Several methods were used to document the usefulness and feasibility of the SIPP. Data were collected using self-report questionnaires completed by seven radiotherapists and 268 cancer patients. Results Regarding the screening procedure 33 patients were offered to consult a psychosocial care provider (e.g. social worker, psychologist) during the first consultation with their radiotherapist. Of these patients, 31 patients suffered from at least sub-clinical symptoms and two patients hardly suffered from any symptoms. Patients' acceptance rate 63.6% (21/33) was high. Patients were positive about the content of the SIPP (mean scores vary from 8.00 to 8.88, out of a range between 0 and 10) and about the importance of discussing items of the SIPP with their radiotherapist (mean score = 7.42). Radiotherapists' perspectives about the contribution of the SIPP to discuss the different psychosocial problems were mixed (mean scores varied from 3.17 to 4.67). Patients were more positive about discussing items of the SIPP if the radiotherapists had positive attitudes towards screening and discussing psychosocial problems. Conclusions The screening procedure appeared to be feasible in a radiotherapy department. In general, patients' perspectives were at least moderate. Radiotherapists considered the usefulness and feasibility of the SIPP generally to be lower, but their evaluations were mixed. A positive attitude to using screening instruments like the SIPP needs to be encouraged among radiotherapists, as this may not only improve the usefulness of a screening instrument, but also patients' satisfaction with care. Trial Registration ClinicalTrials.gov: NCT00859768
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Affiliation(s)
- Anna P B M Braeken
- Maastricht University, Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands.
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