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Schulze JB, Dörner M, Huber M, Jordan KD, Känel RV, Euler S. Psychiatric Diagnoses and Their Treatment in Women With Breast Cancer: A Latent Class Analysis of 1062 Inpatients. Clin Breast Cancer 2024:S1526-8209(24)00176-9. [PMID: 39153934 DOI: 10.1016/j.clbc.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 05/11/2024] [Accepted: 06/14/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Psycho-oncological support (POS) and psychopharmacological interventions are effective in treating psychiatric symptoms in patients with breast cancer. However, despite high prevalences of psychiatric disorders in patients with breast cancer, a significant proportion remains untreated. METHODS Data from 1062 breast cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2012 and 2019 were analyzed retrospectively. We descriptively evaluated the number of patients with a psychiatric diagnosis, POS and psychiatric medication. Latent class analysis was used to examine the relationship between ICD-10 coded psychiatric diagnoses, POS, psychiatric medication, and, as important prognostic factors, tumor stage and somatic comorbidity. RESULTS 31.5% of all patients had a psychiatric diagnosis, 20% received POS and up to 60% received psychiatric medication. Latent class analysis revealed three subgroups: 1) patients with a low cancer stage, low somatic comorbidity, no psychiatric diagnosis, no POS and no psychiatric medication; 2) patients with a low cancer stage, low somatic comorbidity, a psychiatric diagnosis, and a higher probability of POS and psychiatric medication than class 1 and class 3; 3) patients with advanced cancer stage, high somatic comorbidity, a higher probability of a psychiatric diagnosis and POS than class 1, and no psychiatric medication. CONCLUSION This study indicated a high prevalence of psychiatric disorders among patients with breast cancer and a discrepancy between the number of patients having a psychiatric disorder and those receiving psychiatric medication. The identification of subgroups might contribute to better tailored treatment for those patients whose needs are insufficiently met.
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Affiliation(s)
- Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland.
| | - Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland; German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, Magdeburg, Saxony-Anhalt, Germany
| | - Mona Huber
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland
| | - Katja-Daniela Jordan
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Zurich, Switzerland
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Jan Ben S, Dörner M, Günther MP, von Känel R, Euler S. Proof of concept: Predicting distress in cancer patients using back propagation neural network (BPNN). Heliyon 2023; 9:e18328. [PMID: 37576295 PMCID: PMC10412887 DOI: 10.1016/j.heliyon.2023.e18328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Background Research findings suggest that a significant proportion of individuals diagnosed with cancer, ranging from 25% to 60%, experience distress and require access to psycho-oncological services. Until now, only contemporary approaches, such as logistic regression, have been used to determine predictors of distress in oncological patients. To improve individual prediction accuracy, novel approaches are required. We aimed to establish a prediction model for distress in cancer patients based on a back propagation neural network (BPNN). Methods Retrospective data was gathered from a cohort of 3063 oncological patients who received diagnoses and treatment spanning the years 2011-2019. The distress thermometer (DT) has been used as screening instrument. Potential predictors of distress were identified using logistic regression. Subsequently, a prediction model for distress was developed using BPNN. Results Logistic regression identified 13 significant independent variables as predictors of distress, including emotional, physical and practical problems. Through repetitive data simulation processes, it was determined that a 3-layer BPNN with 8 neurons in the hidden layer demonstrates the highest level of accuracy as a prediction model. This model exhibits a sensitivity of 79.0%, specificity of 71.8%, positive predictive value of 78.9%, negative predictive value of 71.9%, and an overall coincidence rate of 75.9%. Conclusion The final BPNN model serves as a compelling proof of concept for leveraging artificial intelligence in predicting distress and its associated risk factors in cancer patients. The final model exhibits a remarkable level of discrimination and feasibility, underscoring its potential for identifying patients vulnerable to distress.
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Affiliation(s)
- Schulze Jan Ben
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marc Dörner
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Simnacher F, Götz A, Kling S, Schulze JB, von Känel R, Euler S, Günther MP. A short screening tool identifying systemic barriers to distress screening in cancer care. Cancer Med 2023; 12:17313-17321. [PMID: 37439075 PMCID: PMC10501250 DOI: 10.1002/cam4.6331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 06/09/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION International guidelines on cancer treatment recommend screening for early detection and treatment of distress. However, screening rates are insufficient. In the present study, a survey was developed to assess perceived systemic barriers to distress screening. METHODS A three-step approach was used for the study. Based on qualitative content analysis of interviews and an expert panel, an initial survey with 53 questions on barriers to screening was designed. It was completed by 98 nurses in a large comprehensive cancer center in Switzerland. From this, a short version of the survey with 24 questions was derived using exploratory principal component analysis. This survey was completed by 150 nurses in four cancer centers in Switzerland. A confirmatory factor analysis was then performed on the shortened version, yielding a final set of 14 questions. RESULTS The initial set of 53 questions was reduced to a set of 14 validated questions retaining 53% of the original variance. These 14 questions allow for an assessment within 2-3 min that identifies relevant barriers to distress screening from the perspective of those responsible for implementation of distress screening. Across several hospitals in Switzerland, the timing of the first distress screening, lack of capacity, patient and staff overload, and refusal of distressed patients to be referred to support services emerged as major problems. CONCLUSION The validated 14 questions on barriers to screening cancer patients for distress enable clinicians and hospital administrators to quickly identify relevant issues and take action to improve screening programs.
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Affiliation(s)
- Felice Simnacher
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Anna Götz
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sabine Kling
- Computer Vision Laboratory, Department of Information Technology and Electrical EngineeringSwiss Federal Institute of Technology (ETH) ZurichZurichSwitzerland
| | - Jan Ben Schulze
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Roland von Känel
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Sebastian Euler
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - Moritz Philipp Günther
- Department of Consultation‐Liaison Psychiatry and Psychosomatic Medicine, University Hospital ZurichUniversity of ZurichZurichSwitzerland
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Hahn EE, Munoz-Plaza CE, Lyons LJ, Lee JS, Pounds D, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Gould MK. Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study. Support Care Cancer 2023; 31:461. [PMID: 37436477 DOI: 10.1007/s00520-023-07922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial. METHODS Guided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes. RESULTS We conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership "champions." CONCLUSIONS Findings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology. TRIAL REGISTRATION ClinicalTrials.gov #NCT02941614.
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Janet S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
- Southern California Permanente Medical Group Performance Assessment team (as of 11/2020), Pasadena, CA, USA
| | | | - Farah M Brasfield
- Southern California Permanente Medical Group, Department of Medical Oncology, Anaheim, CA, USA
| | - Lara N Durna
- Southern California Permanente Medical Group, Department of Medical Oncology, South Bay, CA, USA
| | - Karen W Kwan
- Southern California Permanente Medical Group, Department of Medical Oncology, Los Angeles, CA, USA
| | - David B Beard
- Southern California Permanente Medical Group, Department of Medical Oncology, Woodland Hills, CA, USA
| | - Alexander Ferreira
- Southern California Permanente Medical Group, Department of Medical Oncology, West Los Angeles, CA, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Dempsey K, Saw R, Bartula I, Lo S, Lawn C, Pennington T, Spillane A, Boyle F, Dong S, Dieng M, Milne D, Seaman L, Saks D, Lai-Kwon J, Thompson JR, Morton R. Embedding electronic patient-reported outcome measures into routine care for patients with stage III MELanoma (ePROMs-MEL): protocol for a prospective, longitudinal, mixed-methods pilot study. BMJ Open 2022; 12:e066852. [PMID: 36600423 PMCID: PMC9772660 DOI: 10.1136/bmjopen-2022-066852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The benefits of patient-reported feedback, using questionnaires that allow patients to report how they feel and function without any interpretation from healthcare professionals, are well established. However, patient-reported outcomes measures (PROMs) are not routinely collected in patients with melanoma in Australia. The aim of this study is to evaluate the feasibility and acceptability of implementing electronic PROMs (ePROMs) into routine care from the perspectives of patients with stage III melanoma and their treating clinical team. METHODS AND ANALYSIS A minimum of 50 patients and 5 clinicians will be recruited to this prospective, longitudinal pilot study (ePROMs-MELanoma). The study uses a mixed-methods approach (quantitative PROMs questionnaires and end-of-study surveys with qualitative interviews) and commenced in May 2021 in surgical and medical melanoma clinics at two sites in metropolitan Sydney, Australia. The primary outcomes are measures of feasibility and acceptability, comprising descriptive questionnaire completion statistics, and proportion of patients who reported that these PROMs were easy to complete and measured items they considered important. Clinician and clinic staff views will be canvassed on the appropriateness of these PROMs for their patients, change in referral practice and uptake and incorporation into routine practice. Secondary aims include measurement of improvements in patients' emotional and physical health and well-being, and utility of real-time data capture and clinician feedback. All participants will complete the Distress Thermometer and EQ-5D-5L questionnaires in the clinic using a tablet computer at baseline and two to three subsequent follow-up appointments. Participants who report a score of 4 or higher on the Distress Thermometer will be triaged to complete an additional three questionnaires: the QLQ-C30, Depression, Anxiety and Stress Scale and Melanoma Concerns Questionnaire-28. Results will be generated in real time; patients with psychosocial distress or poor quality of life will discuss possible referral to appropriate allied health services with their clinician. Thematic analysis of interviews will be conducted. ETHICS AND DISSEMINATION Ethics approval obtained from St Vincent's Hospital Human Research Ethics Committee on 19 September 2019 (2019/ETH10558), with amendments approved on 8 June 2022. Patient consent is obtained electronically prior to questionnaire commencement. Dissemination strategies will include publication in peer-reviewed journals and presentation at international conferences, tailored presentations for clinical societies and government bodies, organisational reporting through multidisciplinary meetings and research symposia for local clinicians and clinic staff, and more informal, lay reports and presentations for consumer melanoma representative bodies and patient participants and their families. TRIAL REGISTRATION NUMBER ACTRN12620001149954.
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Affiliation(s)
- Kathy Dempsey
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Saw
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Iris Bartula
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Serigne Lo
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Craig Lawn
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Thomas Pennington
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Andrew Spillane
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Skye Dong
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Donna Milne
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Seaman
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Dina Saks
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | - Julia Lai-Kwon
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
| | | | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Melanoma Institute Australia, Wollstonecraft, New South Wales, Australia
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach. Palliat Support Care 2022:1-8. [PMID: 36367151 DOI: 10.1017/s1478951522001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. METHODS In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. RESULTS Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. SIGNIFICANCE OF RESULTS To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Anja Kröner
- Department of Oncology, Cantonal Hospital Glarus AG, Glarus, Switzerland
| | - Josef Jenewein
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, University Hospital Graz, Graz, Austria
- Private Clinic Hohenegg, Meilen, Switzerland and University of Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Reading Wishes from the Lips: Cancer Patients' Need for Psycho-Oncological Support during Inpatient and Outpatient Treatment. Diagnostics (Basel) 2022; 12:diagnostics12102440. [PMID: 36292128 PMCID: PMC9600894 DOI: 10.3390/diagnostics12102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Psycho-oncological support (PO) is an effective measure to reduce distress and improve the quality of life in patients with cancer. Currently, there are only a few studies investigating the (expressed) wish for PO. The aim of this study was to evaluate the number of patients who request PO and to identify predictors for the wish for PO. Methods: Data from 3063 cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2011 and 2019 were analyzed retrospectively. Potential predictors for the wish for PO were identified using logistic regression. As a novelty, a Back Propagation Neural Network (BPNN) was applied to establish a prediction model for the wish for PO. Results: In total, 1752 patients (57.19%) had a distress score above the cut-off and 14.59% expressed the wish for PO. Patients’ requests for pastoral care (OR = 13.1) and social services support (OR = 5.4) were the strongest predictors of the wish for PO. Patients of the female sex or who had a current psychiatric diagnosis, opioid treatment and malignant neoplasms of the skin and the hematopoietic system also predicted the wish for PO, while malignant neoplasms of digestive organs and older age negatively predicted the wish for PO. These nine significant predictors were used as input variables for the BPNN model. BPNN computations indicated that a three-layer network with eight neurons in the hidden layer is the most precise prediction model. Discussion: Our results suggest that the identification of predictors for the wish for PO might foster PO referrals and help cancer patients reduce barriers to expressing their wish for PO. Furthermore, the final BPNN prediction model demonstrates a high level of discrimination and might be easily implemented in the hospital information system.
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Hart NH, Crawford-Williams F, Crichton M, Yee J, Smith TJ, Koczwara B, Fitch MI, Crawford GB, Mukhopadhyay S, Mahony J, Cheah C, Townsend J, Cook O, Agar MR, Chan RJ. Unmet supportive care needs of people with advanced cancer and their caregivers: a systematic scoping review. Crit Rev Oncol Hematol 2022; 176:103728. [PMID: 35662585 DOI: 10.1016/j.critrevonc.2022.103728] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 01/11/2023] Open
Abstract
Examining and addressing unmet care needs is integral to improving the provision and quality of cancer services. This review explored the prevalence of unmet supportive care needs, and factors associated with unmet need, in adults with advanced cancers (solid and hematological malignancies) and their caregivers. Electronic databases (PubMed, CINAHL, EMBASE) were searched, producing 85 papers representing 81 included studies. People with advanced cancer reported the highest unmet needs in financial, health system and information, psychological, and physical and daily living domains, whereas caregivers reported the highest unmet needs in psychological, and patient care and support domains. Distress, depression, and anxiety were associated with higher unmet needs across all unmet need domains for people with advanced cancer and their caregivers. Substantial heterogeneity in study populations and methods was observed. Findings from this review can inform targeted strategies and interventions to address these unmet needs in people with advanced cancer.
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Affiliation(s)
- Nicolas H Hart
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, WA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Institute for Health Research, University of Notre Dame Australia, WA, Australia.
| | - Fiona Crawford-Williams
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia; Nutrition and Dietetics Research Group, Bond University, QLD, Australia
| | - Jasmine Yee
- Centre for Medical Psychology and Evidence-Based Decision-Making, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Thomas J Smith
- Division of General Internal Medicine, John Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bogda Koczwara
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, SA, Australia; Flinders Cancer and Innovation Centre, Flinders Medical Centre, SA, Australia
| | - Margaret I Fitch
- School of Graduate Studies, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gregory B Crawford
- Discipline of Medicine, University of Adelaide, SA, Australia; Northern Adelaide Local Health Network, SA, Australia
| | - Sandip Mukhopadhyay
- Burdwan Medical College, West Bengal, Kolkata, India; Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | - Chan Cheah
- Internal Medicine, UWA Medical School, University of Western Australia, WA, Australia; Department of Haematology, Sir Charles Gairdner Hospital, WA, Australia; Department of Haematology, Hollywood Private Hospital, WA, Australia
| | | | - Olivia Cook
- McGrath Foundation, NSW, Australia; School of Nursing and Midwifery, Monash University, VIC, Australia
| | - Meera R Agar
- IMPACCT Centre, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, SA, Australia; Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, QLD, Australia
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Patterson P, McDonald FEJ, Allison KR, Bibby H, Osborn M, Matthews K, Sansom-Daly UM, Thompson K, Plaster M, Anazodo A. The Clinical Utility of the Adolescent and Young Adult Psycho-Oncology Screening Tool (AYA-POST): Perspectives of AYA Cancer Patients and Healthcare Professionals. Front Psychol 2022; 13:872830. [PMID: 35602702 PMCID: PMC9120841 DOI: 10.3389/fpsyg.2022.872830] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/21/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Routine psychosocial screening and assessment of people diagnosed with cancer are crucial to the timely detection of distress and provision of tailored supportive care; however, appropriate screening tools have been lacking for adolescents and young adults (AYAs), who have unique needs and experiences. One exception is the recently validated AYA Psycho-Oncology Screening Tool (AYA-POST) for use with young people aged 15–29 years, which comprises a distress thermometer and age-specific needs assessment. This study investigates the clinical utility of this measure, as well as the subsequent service responsiveness within the Australian Youth Cancer Services. Method In total, 118 AYAs and 29 healthcare professionals: (HCPs) completed surveys about the clinical utility of the AYA-POST; a subset of 30 AYAs completed a 3-month follow-up survey assessing service responsiveness. Descriptive statistics (frequencies/means) were computed for all items, with chi-square analyses used to explore whether perceived clinical utility varied with AYA age, AYA sex, HCP discipline or HCP length of time using the AYA-POST. Results Participants’ responses demonstrate high levels of satisfaction with the tool, evidencing its appropriateness, practicability and acceptability. Moreover, the AYA-POST was reported to facilitate communication about psychosocial needs and prompt referrals, indicating good service responsiveness. Ratings of clinical utility did not differ significantly between AYA and HCP groups. Conclusion This study demonstrates that the AYA-POST is an appropriate tool in the psychosocial screening of AYAs with cancer, facilitating the identification of distress and unique concerns in this population and valuable in triaging and tailoring care for young cancer patients.
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Affiliation(s)
- Pandora Patterson
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Pandora Patterson,
| | - Fiona E. J. McDonald
- Canteen Australia, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Michael Osborn
- South Australia/Northern Territory Youth Cancer Service, Royal Adelaide Hospital, Adelaide, SA, Australia
- Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Karen Matthews
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
| | - Ursula M. Sansom-Daly
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Behavioural Sciences Unit, School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics and Child Health, University of New South Wales, Sydney, NSW, Australia
| | - Kate Thompson
- Victoria/Tasmania Youth Cancer Service, Melbourne, VIC, Australia
| | - Meg Plaster
- Western Australia Youth Cancer Service, Perth, WA, Australia
| | - Antoinette Anazodo
- New South Wales/Australian Capital Territory Youth Cancer Service, Sydney, NSW, Australia
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
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Butow P, Shepherd HL, Cuddy J, Rankin N, Harris M, He S, Grimison P, Girgis A, Faris M, Shaw J. Staff perspectives on the feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations. BMC Health Serv Res 2022; 22:192. [PMID: 35164772 PMCID: PMC8842573 DOI: 10.1186/s12913-022-07532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/14/2021] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Clinical pathways (CPs) are intended to standardise and improve care but do not always produce positive outcomes, possibly because they were not adapted to suit the specific context in which they were enacted. This qualitative study aimed to explore staff perspectives of implementation of a CP for routine screening, assessment, referral and management of anxiety and depression (the ADAPT CP) for patients with cancer, focussing on perceived feasibility of the CP and negotiated adaptations made during the implementation phase. METHODS The ADAPT CP was implemented in 12 urban and regional oncology services in Australia. Services were randomised to receive core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Purposively selected staff were interviewed prior to implementation (n = 88) and 6 months later, half-way through the implementation period (n = 89). Monthly meetings with lead multi-disciplinary teams at the eight enhanced sites were recorded. Data were thematically analysed. RESULTS Six overarching themes were identified: ADAPT is of high value; timing for introducing the CP and screening is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micro-logistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to in-clinic or phone screening, or repeated email reminders. Staff negative attitudes to ADAPT, time constraints, and perceived poor fit of ADAPT to work roles and flows, all impacted implementation, with key tasks often devolving to a few key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success. CONCLUSIONS This study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes. TRIAL REGISTRATION The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347.
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Affiliation(s)
- Phyllis Butow
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Heather L Shepherd
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia.
| | - Jessica Cuddy
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Nicole Rankin
- The University of Sydney, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Marnie Harris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Sharon He
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | | | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Kensington, Australia
| | - Mona Faris
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
| | - Joanne Shaw
- The University of Sydney, School of Psychology, Psycho-Oncology Co-operative Research Group (PoCoG), Sydney, NSW, 2006, Australia
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11
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Hahn EE, Munoz-Plaza CE, Pounds D, Lyons LJ, Lee JS, Shen E, Hong BD, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Padmanabhan A, Gould MK. Effect of a Community-Based Medical Oncology Depression Screening Program on Behavioral Health Referrals Among Patients With Breast Cancer: A Randomized Clinical Trial. JAMA 2022; 327:41-49. [PMID: 34982119 PMCID: PMC8728610 DOI: 10.1001/jama.2021.22596] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
Importance Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration ClinicalTrials.gov Identifier: NCT02941614.
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Affiliation(s)
- Erin E. Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Now with Southern California Permanente Medical Group Performance Assessment team, Pasadena
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Janet S. Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Benjamin D. Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Farah M. Brasfield
- Department of Medical Oncology, Southern California Permanente Medical Group, Anaheim
| | - Lara N. Durna
- Department of Medical Oncology, Southern California Permanente Medical Group, South Bay
| | - Karen W. Kwan
- Department of Medical Oncology, Southern California Permanente Medical Group, Los Angeles
| | - David B. Beard
- Department of Medical Oncology, Southern California Permanente Medical Group, Woodland Hills
| | - Alexander Ferreira
- Department of Medical Oncology, Southern California Permanente Medical Group, West Los Angeles
| | - Aswini Padmanabhan
- Department of Medical Oncology, Southern California Permanente Medical Group, Baldwin Park
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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12
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McCarter K, Carlson MA, Baker AL, Paul CL, Lynam J, Johnston LN, Fradgley EA. A qualitative study investigating Australian cancer service outpatients' experience of distress screening and management: what is the personal relevance, acceptability and improvement opportunities from patient perspectives? Support Care Cancer 2021; 30:2693-2703. [PMID: 34822001 PMCID: PMC8794887 DOI: 10.1007/s00520-021-06671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
Purpose People diagnosed with cancer experience high distress levels throughout diagnosis, treatment, and survivorship. Untreated distress is associated with poor outcomes, including worsened quality of life and higher mortality rates. Distress screening facilitates need-based access to supportive care which can optimize patient outcomes. This qualitative interview study explored outpatients’ perceptions of a distress screening process implemented in an Australian cancer center. Methods Adult, English-speaking cancer outpatients were approached to participate in face-to-face or phone interviews after being screened by a clinic nurse using the distress thermometer (DT). The piloted semi-structured interview guide explored perceptions of the distress screening and management process, overall well-being, psychosocial support networks, and improvement opportunities for distress processes. Thematic analysis was used. Results Four key themes were identified in the 19 interviews conducted. Distress screening was found to be generally acceptable to participants and could be conducted by a variety of health professionals at varied time points. However, some participants found “distress” to be an ambiguous term. Despite many participants experiencing clinical distress (i.e., DT ≥ 4), few actioned referrals; some noted a preference to manage and prevent distress through informal support and well-being activities. Participants’ diverse coping styles, such as positivity, acceptance, and distancing, also factored into the perceived value of screening and referrals. Conclusion and implications Screening models only measuring severity of distress may not be sufficient to direct care referrals, as they do not consider patients’ varying coping strategies, external support networks, understanding of distress terminology, and motivations for accessing supportive care services. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06671-2.
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Affiliation(s)
- Kristen McCarter
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Melissa A Carlson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Chris L Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - James Lynam
- Calvary Mater Hospital Newcastle, Hunter New England Health, Waratah, Australia
| | - Lana N Johnston
- Calvary Mater Hospital Newcastle, Hunter New England Health, Waratah, Australia
| | - Elizabeth A Fradgley
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
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13
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Screening for distress in cancer care: How to overcome barriers after unsuccessful implementation? Palliat Support Care 2021; 20:1-3. [PMID: 34809730 DOI: 10.1017/s1478951521001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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Günther MP, Kirchebner J, Schulze JB, Götz A, von Känel R, Euler S. Uncovering Barriers to Screening for Distress in Patients With Cancer via Machine Learning. J Acad Consult Liaison Psychiatry 2021; 63:163-169. [PMID: 34438098 DOI: 10.1016/j.jaclp.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/12/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychologic distress and manifest mental disorders are overlooked in 30-50% of patients with cancer. Accordingly, international cancer treatment guidelines recommend routine screening for distress in order to provide psychologic support to those in need. Yet, institutional and patient-related factors continue to hinder implementation. OBJECTIVE This study aims to investigate factors, which are associated with no screening for distress in patients with cancer. METHODS Using machine learning, factors associated with lack of distress screening were explored in 6491 patients with cancer between 2011 and 2019 at a large cancer treatment center. Parameters were hierarchically ordered based on statistical relevance. Nested resampling and cross validation were performed to avoid overfitting and to comply with assumptions for machine learning approaches. RESULTS Patients unlikely to be screened were not discussed at a tumor board, had inpatient treatment of less than 28 days, did not consult with a psychiatrist or clinical psychologist, had no (primary) nervous system cancer, no head and neck cancer, and did have breast or skin cancer. The final validated model was optimized to maximize sensitivity at 83.9%, and achieved a balanced accuracy of 68.9, area under the curve of 0.80, and specificity of 53.9%. CONCLUSION Findings of this study may be relevant to stakeholders at both a clinical and institutional level in order to optimize distress screening rates.
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Affiliation(s)
- Moritz Philipp Günther
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Jan Ben Schulze
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Götz
- Department of Hemato-Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Euler
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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15
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Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies. Curr Opin Support Palliat Care 2021; 14:220-231. [PMID: 32657813 DOI: 10.1097/spc.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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16
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White VM, Pejoski N, Vella E, Skaczkowski G, Ugalde A, Yuen EYN, Livingston P, Wilson C. Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services. Psychooncology 2021; 30:1603-1625. [PMID: 34133053 DOI: 10.1002/pon.5744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact. METHODS Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken. RESULTS A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed. CONCLUSIONS Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.
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Affiliation(s)
- Victoria M White
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Natalie Pejoski
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Elizabeth Vella
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Gemma Skaczkowski
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Anna Ugalde
- School of Nursing & Midwifery and Institute of Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Eva Y N Yuen
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia.,School of Nursing & Midwifery and Institute of Health Transformation, Deakin University, Burwood, VIC, Australia.,Monash Health, Clayton, VIC, Australia.,School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Patricia Livingston
- School of Nursing & Midwifery and Institute of Health Transformation, Deakin University, Burwood, VIC, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia.,School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
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17
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LeCouteur A, Lehmann C, Knott V. Brief psychological distress screening on a cancer helpline: How nurses introduce, and callers respond to, the Distress Thermometer. Eur J Oncol Nurs 2021; 53:101986. [PMID: 34294575 DOI: 10.1016/j.ejon.2021.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/28/2021] [Accepted: 06/03/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Helplines are increasingly used to provide information and support for people affected by cancer, and the distress routinely associated with diagnosis and treatment is a major focus for those providing such care. Little is known, however, about how the Distress Thermometer (DT), a widely used tool for the assessment of patient/carer distress on cancer-support telephone helplines, is introduced and used in such settings. METHOD Using the method of conversation analysis, we present a qualitative analysis of DT use in actual telephone interactions by looking closely at how particular practices shape interaction on a cancer helpline. Specifically, we examine how oncology-trained nurse call-takers used the DT, in situ, as a tool for assessing callers, as well as examining how callers responded to this brief screening tool. RESULTS Our findings show how particular positioning of the DT in the call, and particular forms of its delivery, tend to generate brief responses from callers that avoid topicalization of distress, and tend not to be associated with referral to support services. CONCLUSIONS Implications for successful integration of the DT as a screening tool in cancer- and other health-helpline interactions, as well as for effective training of users, are discussed.
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Affiliation(s)
- Amanda LeCouteur
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Claire Lehmann
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - Vikki Knott
- School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
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18
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Götz A, Kröner A, Jenewein J, Spirig R. Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer? Pflege 2021; 34:71-79. [PMID: 33535833 DOI: 10.1024/1012-5302/a000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category "Trying to perform useful screening in a complex daily routine" comprises three subcategories: "Using the benefits of screening for comprehensive care", "The best way to recognize the individuality of the counterpart" and "Failing due to structural and personal barriers". Three further main categories addressing nurses' personal attitudes complete the screening experience: "Experiencing fewer difficulties due to competence and experience", "Being careful due to hesitations", and "Reflecting one's responsibility". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Center Zürich, Universitätsspital Zürich.,PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke
| | | | - Josef Jenewein
- Triaplus Ag - Integrierte Psychiatrie Uri, Schwyz und Zug
| | - Rebecca Spirig
- PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke.,Institut für Pflegewissenschaft, Universität Basel
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19
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Dreismann L, Goretzki A, Ginger V, Zimmermann T. What if… I Asked Cancer Patients About Psychological Distress? Barriers in Psycho-Oncological Screening From the Perspective of Nurses-A Qualitative Analysis. Front Psychiatry 2021; 12:786691. [PMID: 35153856 PMCID: PMC8825354 DOI: 10.3389/fpsyt.2021.786691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Screening questionnaires to assess psychological distress in cancer patients are well-established, but in practice there are difficulties in implementation screening up to referral to psycho-oncology. Interdisciplinary collaboration between psycho-oncology, physicians, and nursing is very important to this process. However, there are barriers and obstacles on all sides. OBJECTIVE The aim of this study is to capture in particular the barriers from the perspective of oncology nursing. MATERIALS AND METHODS Semi-structured interviews with nursing experts (n = 15; n = 10 female; 24-62 years) from different oncology departments of three university hospitals in Germanys were conducted and qualitative content analysis was carried out by two raters. RESULTS The Screening routine is variably well-integrated into daily clinical practice. Structural barriers such as time pressure and a lack of focus on mental distress in nursing are present. Barriers on the side of nurses are primarily a lack of knowledge and communication insecurities when dealing with patients. CONCLUSIONS There is a need for training and implementation of a disciplinary screening approach. The structural and organizational barriers, which are a challenge for the successful screening process due to unfavorable interdisciplinary team communication and clinical daily structure, should be addressed in further studies. Implications for Practice: In order to establish an interdisciplinary screening process and to overcome the barriers, trainings to deal with knowledge deficits and insecurities seem to be useful.
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Affiliation(s)
- Lara Dreismann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alina Goretzki
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Viktoria Ginger
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Tanja Zimmermann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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20
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Dekker J, Karchoud J, Braamse AMJ, Buiting H, Konings IRHM, van Linde ME, Schuurhuizen CSEW, Sprangers MAG, Beekman ATF, Verheul HMW. Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding". Transl Behav Med 2020; 10:1399-1405. [PMID: 33200793 PMCID: PMC7796719 DOI: 10.1093/tbm/ibaa115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The current approach to the management of emotions in patients with cancer is “distress screening and referral for the provision of psychosocial care.” Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of “emotional support and case finding” as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Jeanet Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Hilde Buiting
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Inge R H M Konings
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud UMC, Nijmegen, the Netherlands
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21
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Newton JC, O'Connor M, Saunders C, Moorin R, Ali S, Nowak AK, Halkett GKB. The role of psychosocial support in the experiences of people living with advanced cancer: A qualitative exploration of patients' perspectives. Psychooncology 2020; 30:287-295. [PMID: 33037707 DOI: 10.1002/pon.5569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/21/2020] [Accepted: 10/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND People living with advanced cancer experience significant distress and reduced quality of life due to their symptom burden and life-limiting prognosis. Limited qualitative research has investigated their experiences accessing psychosocial supportive care, and how it meets their needs. AIM To explore patients' perspectives of the role of psychosocial support in their experiences of living with advanced cancer. METHODS This study used an exploratory qualitative research design and drew upon a social constructionist interpretive framework. Semi-structured interviews were conducted with 23 participants. Participants were asked about their experiences accessing and using psychosocial support following their diagnosis. Audio-recorded interviews were transcribed and analysed using deductive thematic analysis. RESULTS The following six themes can be used to describe participants' experiences with psychosocial support: (1) accessing different types of support, (2) appreciating support, (3) need, (4) difficulties accessing support, (5) knowing about support and (6) asking for support. Sources of psychosocial support included family and friends, health professionals, and psychosocial supportive care services. Not all participants were able to access care that met their needs; barriers included suitability of available support, accessibility and stigma surrounding support use. CONCLUSION Participants experienced broad variation in their awareness and access to psychosocial support services to meet their needs. Providers of psychosocial supportive care for advanced cancer patients need to consider service accessibility issues. Future psychosocial interventions targeting people living with advanced cancer should consider these issues during development and implementation.
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Affiliation(s)
- Jade C Newton
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- WA Cancer Prevention Research Unit (WACPRU), School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sayed Ali
- Medical Oncology Department, St John of God Midland Public Hospital, Midland, Western Australia, Australia
| | - Anna K Nowak
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Taylor J, Fradgley EA, Clinton-McHarg T, Roach D, Paul CL. Distress screening and supportive care referrals used by telephone-based health services: a systematic review. Support Care Cancer 2019; 28:2059-2069. [PMID: 31872298 DOI: 10.1007/s00520-019-05252-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/16/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE People affected by chronic diseases such as cancer report high levels of distress and a need for psychosocial support. It is unclear whether telephone-based services for people affected by chronic disease are a practical setting for implementing distress screening, referral protocols and rescreening to direct supportive care where it is needed. This systematic review aimed to describe the published literature regarding distress screening and supportive care referral practices in telephone-based services for people affected by chronic diseases such as cancer. METHODS A systematic literature search of MEDLINE, Embase, PsycInfo, CINAHL, Cochrane and Scopus was conducted in February 2018. Included quantitative studies involved: patients or caregivers affected by chronic diseases including cancer and describe a health service assessing psychosocial needs or distress via telephone. Extracted data included the type of cancer or other chronic disease, sample size, screening tool, referral or rescreening protocols, and type of health service. RESULTS The search identified 3989 potential articles with additional searches returning 30 studies (n = 4019); fourteen were eligible for full-text review. Of the 14 studies, 13 included cancer patients. Studies were across multiple settings and identified nine distress screening tools in use. CONCLUSION The reviewed studies indicate that validated distress-screening tools are being used via telephone to identify distress, particularly in relation to cancer. Screening-driven supportive care referrals are also taking place in telephone-based services. However, not all services use an established referral protocol. Ongoing rescreening of callers' distress is also limited despite it being an important recommendation from psycho-oncology guidelines.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Cancer Research Innovation and Translation, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Elizabeth A Fradgley
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Cancer Institute New South Wales, Level 9, 8 Central Ave, Australian Technology Park, Eveleigh, NSW, 2015, Australia
| | - Tara Clinton-McHarg
- Priority Research Centre for Health Behaviour, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,School of Psychology, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Della Roach
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia
| | - Chris L Paul
- School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Cancer Research Innovation and Translation, Level 4 West, HMRI Building, Callaghan, NSW, 2308, Australia
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