Building psychosocial capacity through training of front-line health professionals to provide brief therapy: lessons learned from the PROMPT study

The application of stepped-wedge cluster-randomized controlled trial study designs in oncology settings: A systematic review

Stepped-wedge cluster-randomised trials (SW-CRTs) offer advantages for implementation research in healthcare and have been increasingly utilised in the oncology setting. Cancer-related SW-CRTs need to be robust to deliver impactful trial outcomes and support effective translation into practice. This review aimed to examine the application of the SW-CRT design in oncology settings including the trial design features and protocol deviations, the interventions tested, and the implementation aspects of those interventions. Five databases were searched from database inception to July 2023 for SW-CRTs which evaluated interventions in adults with cancer. Intervention characteristics, design features, protocol deviations, statistical approach, implementation strategies, and outcomes were described and evaluated narratively. The search yielded 3,395 unique records with representing 15 trials which are reported over 49 publications. The 15 trials (n=8 efficacy trials and n=7 implementation trials) described diverse interventions in healthcare settings. Trials supported implementation of the intervention via educating and training healthcare professionals (n=12; 80%), met or exceeded recruitment targets (n=10, 67%) and evaluated a new model of care (n=7; 47%). Despite implementation outcomes being reported in 14 (93%) trials, 12 (86%) did not use an established evaluation framework to guide the selection and reporting of implementation outcomes. SW-CRTs were a utilised design for implementing diverse and complex healthcare interventions in the oncology setting. Trialists should consider the need to incorporate implementation frameworks, strategies and outcomes into their trial planning and resource allocation. This strategic approach can enhance the design and impact of SW-CRTs, leading to improved patient outcomes and advancements in cancer care.

Dynamic prediction of lung cancer suicide risk based on meteorological factors and clinical characteristics：A landmarking analysis approach

Suicide is a severe public health issue globally. Accurately identifying high-risk lung cancer patients for suicidal behavior and taking timely intervention measures has become a focus of current research. This study intended to construct dynamic prediction models for identifying suicide risk among lung cancer patients. Patients were sourced from the Surveillance, Epidemiology, and End Results database, while meteorological data was acquired from the Centers for Disease Control and Prevention. This cohort comprised 455, 708 eligible lung cancer patients from January 1979 to December 2011. A Cox proportional hazard regression model based on landmarking approach was employed to explore the impact of meteorological factors and clinical characteristics on suicide among lung cancer patients, and to build dynamic prediction models for the suicide risk of these patients. Additionally, subgroup analyses were conducted by age and sex. The model's performance was evaluated using the C-index, Brier score, area under curve (AUC) and calibration plot. During the study period, there were 666 deaths by suicide among lung cancer patients. Multivariable Cox results from the dynamic prediction model indicated that age, marital status, race, sex, primary site, stage, monthly average daily sunlight, and monthly average temperature were significant predictors of suicide. The dynamic prediction model demonstrated well consistency and discrimination capabilities. Subgroup analyses revealed that the association of monthly average daily sunlight and monthly average temperature with suicide remained significant among female and younger lung cancer patients. The dynamic prediction model can effectively incorporate covariates with time-varying to predict lung cancer patients' suicide death. The results of this study have significant implications for assessing lung cancer individuals' suicide risk.

Depression: Screening, Assessment, and Interventions in Oncology Nursing

BACKGROUND

A high prevalence of depression exists among individuals with cancer, which negatively affects their health outcomes, quality of life, and adherence to cancer treatment.

OBJECTIVES

This article provides an overview and synthesis of depression screening, assessment, and nonpharmacologic treatments to help oncology nurses in their practices.

METHODS

Key insights are presented from a synthesized literature review regarding patients with cancer with depression. Resources for patient treatment and nurse training are also provided.

FINDINGS

To improve patient outcomes, nurses need to understand and follow a process that addresses the screening, assessment, and nonpharmacologic treatment of depression in patients with cancer.

Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies

PURPOSE OF REVIEW

Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services.

RECENT FINDINGS

Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies.

SUMMARY

Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.

Improving survivorship care: Perspectives of cancer survivors 75 years and older

PURPOSE

This work describes perspectives of older adult cancer survivors about improvements that should be considered during the early period of survivorship. Findings will be useful in program development of age-appropriate services following completion of cancer treatment for older adults.

METHODS

A national survey was conducted across ten Canadian provinces to understand follow-up experiences of cancer survivors one to three years post-treatment. The survey included open-ended questions enabling respondents to offer insight into their experiences. This publication presents analysis of responses from older adults (75+ years) about suggestions for improving survivorship care.

RESULTS

In total, 3274 older adults (75+ years) responded to the survey and 1424 responded to the question about improvements. Fifty-five percent of the older adults were male, 28% had experienced metastatic disease and 75% reported comorbid conditions. A total of 640 respondents offered 932 suggestions in the areas of service delivery (n = 763, 81.9%), support (n = 108, 11.6%), and practical assistance (n = 61, 6.5%). Improvements in information/communication (n = 291) and follow-up care (n = 180) accounted for the highest number of suggestions regarding service delivery. Thematic analysis revealed three key messages about improvement: 'offer me needed support', 'make access easy for me', and 'show me you care'.

CONCLUSION

Suggestions for improvement in survivorship care by older adults treated for cancer emphasize need for changes in the approaches taken by health care providers in interactions and organization of care delivery. Proactive provision of information, detailed schedules for follow-up care, and ease of access to post-treatment care are needed.

Clinical supervision in oncology: A narrative review

The aim of this narrative literature review is to (a) review all empirical studies of clinical supervision (CS) in oncology and to (b) highlight some CS practice issues distinctive to cancer care. This review identified empirical studies related to qualified professionals and published in English since 1995 that connected to CS and oncology. A total of 15 studies were identified with the majority as small scale, exploratory and qualitative. Psychologists were predominantly utilised as facilitators of the CS with varied sample sizes ranging from 5-230 participants. The studies were grouped into three main categories; the impact of supervision on staff, impact of supervision on professional care/development and impact of supervision in existential exploration. This review highlighted the positive impact of CS while demonstrating the need for more methodologically sound programmes of research into CS in cancer settings so detailed models of effective supervision can develop and thereby inform practice.

Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support

OBJECTIVES

To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.

METHODS

Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory.

RESULTS

Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to.

CONCLUSIONS

Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.

Enhancing clinical practice in the management of distress: The Therapeutic Practices for Distress Management (TPDM) project

OBJECTIVE

The Therapeutic Practices for Distress Management (TPDM) project was carried out to support clinicians in integrating recommendations from four clinical practice guidelines (CPGs) in routine care at five Pan Canadian cancer care sites.

METHODS

Using a concurrent, mixed-method study design and knowledge translation (KT) activities, this project included two phases: phase I-a baseline/preparation phase and phase II-an intervention phase plus evaluation. The intervention phase (the focus of this report) included a one-year education and supervision program (24 hours in virtual class; 12-hour group supervision). Primary outcomes were knowledge and self-efficacy in practicing CPGs as measured by a Knowledge and Self-Efficacy Survey (KSES). A secondary outcome was observer-rated performances with standardized patients (objective structured clinical exams). Participants included 80 (90%) nurses, and 9 (10%) social workers (N = 89).

RESULTS

The TPDM program was effective in accomplishing change in knowledge, self-efficacy, and performance. All measures demonstrated significant change pre and post module, with evidence of increasing knowledge (P < .01) and confidence (P < .01) over time. Further, there was evidence of a shift in barriers and enablers to practicing in alignment with the CPGs.

CONCLUSIONS

A tailored education program using case-based learning and supervision over time improves knowledge and practice among front line clinicians. The findings have implications for quality improvement in cancer care.