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Cranstoun D, Baliousis M, Merdian HL, Rennoldson M. Nurse-Led Psychological Interventions For Depression In Adult Cancer Patients: A Systematic Review And Meta-Analysis of Randomized Controlled Trials. J Pain Symptom Manage 2024; 68:e21-e35. [PMID: 38583500 DOI: 10.1016/j.jpainsymman.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/22/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES Depression, frequently associated with cancer, significantly impacts health outcomes, necessitating effective treatments. This systematic review and meta-analysis aim to synthesize and critically evaluate the evidence from randomized controlled trials (RCTs) for the efficacy of nurse-led psychological interventions in managing depression among adult cancer patients. It focuses on the unique contribution of these interventions to improving depression management in oncology care, an underrepresented area in the existing literature. METHODS We conducted a comprehensive search in databases including Scopus, Medline, CINAHL, and PsycINFO, applying strict criteria to select RCTs assessing nurse-led psychological interventions for depression in cancer patients. We used the Cochrane Risk of Bias 2 tool to assess study quality. RESULTS Out of 425 screened abstracts, nine papers describing seven distinct interventions involving 1463 participants were selected. The overall effect size estimate of -0.75 (95% confidence interval: -1.23 to -0.27) indicates significant effectiveness of these interventions in reducing depression compared to treatment as usual. Additionally, the calculated prediction interval highlights the variability in effectiveness across different settings, suggesting that contextual factors play a crucial role in the success of these interventions. CONCLUSION The findings advocate for the integration of nurse-led psychological interventions into standard cancer care, highlighting their efficacy in improving depressive symptoms in adult cancer patients. These interventions show promise but require further refinement and research to optimize their effectiveness across diverse patient groups and healthcare settings. This review underscores the potential of nurse-led psychological interventions in enriching oncology care and addresses a critical gap in the existing body of research.
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Affiliation(s)
- Dominique Cranstoun
- School of Psychology (D.C., M.B., H.L.M.), University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom.
| | - Michael Baliousis
- School of Psychology (D.C., M.B., H.L.M.), University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom; Nottingham University Hospitals NHS Trust (M.B., M.R.), Queens Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom
| | - Hannah Lena Merdian
- School of Psychology (D.C., M.B., H.L.M.), University of Lincoln, Brayford Pool, Lincoln LN6 7TS, United Kingdom
| | - Mike Rennoldson
- Nottingham University Hospitals NHS Trust (M.B., M.R.), Queens Medical Centre, Derby Road, Nottingham NG7 2UH, United Kingdom
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Kim K, Woo J. Characteristics and Effectiveness of Individual Psychotherapy for Palliative and End-of-Life Care: A Literature Review for Randomized Controlled Trials. Psychiatry Investig 2024; 21:433-448. [PMID: 38810992 PMCID: PMC11136579 DOI: 10.30773/pi.2023.0357] [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: 10/12/2023] [Revised: 02/01/2024] [Accepted: 03/03/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE The introduction of psychotherapy in palliative and end-of-life care settings has become increasingly common and is effective in decreasing many psychological problems. This review reports the characteristics and effectiveness of individual psychotherapeutic interventions for patients receiving palliative and end-of-life care. In addition, the review reports the effectiveness of psychotherapies considering the expected life expectancy. METHODS The PubMed, Google Scholar, and Cochrane Library databases were searched for English-language articles published between January 2000 to May 2023. RESULTS Twenty-six studies were included and classified into a total of nine types of psychotherapies, namely, dignity therapy (DT), life review therapy, narrative therapy, managing cancer and living meaningfully (CALM), individual meaning-centered psychotherapy, meaning and purpose therapy, meaning-making therapy, meaning-of-life therapy, and cognitive therapy. CONCLUSION Most of the psychotherapies provided to patients receiving palliative and end-of-life care showed effectiveness in the reduction of negative emotions and positive factors related to end-of-life issues. Most studies targeted patients with advanced cancer; however, studies on DT did not limit the target group to patients with cancer. Considering the expected life expectancy, CALM was found to be suitable for patients receiving early palliative care.
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Affiliation(s)
- Kyungmin Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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Sohanpal R, Pinnock H, Steed L, Heslop-Marshall K, Kelly MJ, Chan C, Wileman V, Barradell A, Dibao-Dina C, Font Gilabert P, Healey A, Hooper R, Mammoliti KM, Priebe S, Roberts M, Rowland V, Waseem S, Singh S, Smuk M, Underwood M, White P, Yaziji N, Taylor SJ. A tailored psychological intervention for anxiety and depression management in people with chronic obstructive pulmonary disease: TANDEM RCT and process evaluation. Health Technol Assess 2024; 28:1-129. [PMID: 38229579 PMCID: PMC11017633 DOI: 10.3310/pawa7221] [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] [Indexed: 01/18/2024] Open
Abstract
Background People with chronic obstructive pulmonary disease have high levels of anxiety and depression, which is associated with increased morbidity and poor uptake of effective treatments, such as pulmonary rehabilitation. Cognitive-behavioural therapy improves mental health of people with long-term conditions and could potentially increase uptake of pulmonary rehabilitation, enabling synergies that could enhance the mental health of people with chronic obstructive pulmonary disease. Aim Our aim was to develop and evaluate the clinical effectiveness and cost effectiveness of a tailored cognitive-behavioural approach intervention, which links into, and optimises the benefits of, routine pulmonary rehabilitation. Design We carried out a pragmatic multicentre randomised controlled trial using a 1.25 : 1 ratio (intervention : control) with a parallel process evaluation, including assessment of fidelity. Setting Twelve NHS trusts and five Clinical Commissioning Groups in England were recruited into the study. The intervention was delivered in participant's own home or at a local NHS facility, and by telephone. Participants Between July 2017 and March 2020 we recruited adults with moderate/very severe chronic obstructive pulmonary disease and mild/moderate anxiety and/or depression, meeting eligibility criteria for assessment for pulmonary rehabilitation. Carers of participants were invited to participate. Intervention The cognitive-behavioural approach intervention (i.e. six to eight 40- to 60-minute sessions plus telephone support throughout pulmonary rehabilitation) was delivered by 31 trained respiratory healthcare professionals to participants prior to commencing pulmonary rehabilitation. Usual care included routine pulmonary rehabilitation referral. Main outcome measures Co-primary outcomes were Hospital Anxiety and Depression Scale - anxiety and Hospital Anxiety and Depression Scale - depression at 6 months post randomisation. Secondary outcomes at 6 and 12 months included health-related quality of life, smoking status, uptake of pulmonary rehabilitation and healthcare use. Results We analysed results from 423 randomised participants (intervention, n = 242; control, n = 181). Forty-three carers participated. Follow-up at 6 and 12 months was 93% and 82%, respectively. Despite good fidelity for intervention delivery, mean between-group differences in Hospital Anxiety and Depression Scale at 6 months ruled out clinically important effects (Hospital Anxiety and Depression Scale - anxiety mean difference -0.60, 95% confidence interval -1.40 to 0.21; Hospital Anxiety and Depression Scale - depression mean difference -0.66, 95% confidence interval -1.39 to 0.07), with similar results at 12 months. There were no between-group differences in any of the secondary outcomes. Sensitivity analyses did not alter these conclusions. More adverse events were reported for intervention participants than for control participants, but none related to the trial. The intervention did not generate quality-of-life improvements to justify the additional cost (adjusted mean difference £770.24, 95% confidence interval -£27.91 to £1568.39) to the NHS. The intervention was well received and many participants described positive affects on their quality of life. Facilitators highlighted the complexity of participants' lives and considered the intervention to be of potential valuable; however, the intervention would be difficult to integrate within routine clinical services. Our well-powered trial delivered a theoretically designed intervention with good fidelity. The respiratory-experienced facilitators were trained to deliver a low-intensity cognitive-behavioural approach intervention, but high-intensity cognitive-behavioural therapy might have been more effective. Our broad inclusion criteria specified objectively assessed anxiety and/or depression, but participants were likely to favour talking therapies. Randomisation was concealed and blinding of outcome assessment was breached in only 15 participants. Conclusions The tailored cognitive-behavioural approach intervention delivered with fidelity by trained respiratory healthcare professionals to people with chronic obstructive pulmonary disease was neither clinically effective nor cost-effective. Alternative approaches that are integrated with routine long-term condition care are needed to address the unmet, complex clinical and psychosocial needs of this group of patients. Trial registration This trial is registered as ISRCTN59537391. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/146/02) and is published in full in Health Technology Assessment; Vol. 28, No. 1. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Ratna Sohanpal
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Liz Steed
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Moira J Kelly
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire Chan
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Vari Wileman
- School of Mental Health and Psychological Sciences, Institute of Psychiatry, King's College London, London, UK
| | - Amy Barradell
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Paulino Font Gilabert
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Andy Healey
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Richard Hooper
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kristie-Marie Mammoliti
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Stefan Priebe
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mike Roberts
- Safer Care Victoria, Melbourne, Melbourne, VIC, Australia
| | | | | | - Sally Singh
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie Smuk
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Patrick White
- Department of Population Health, School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Nahel Yaziji
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK
| | - Stephanie Jc Taylor
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Hirayama T, Ogawa Y, Ogawa A, Igarashi E, Soejima S, Hata K, Utsumi Y, Mashiko Y, Ogata K, Kayano A, Yanai Y, Suzuki SI. Behavioral activation for depression in patients with advanced cancer: study protocol for a multicenter randomized controlled trial. BMC Cancer 2023; 23:427. [PMID: 37170203 PMCID: PMC10173594 DOI: 10.1186/s12885-023-10926-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/06/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Though behavioral activation (BA) has been shown to be effective for depression, evidence in patients with advanced cancer has not been established. This study aimed to examine the effectiveness of a BA program on depression in this population. METHODS A randomized controlled trial with a wait-list control group (waiting group) of 38 patients with advanced cancer and depression will be conducted at three sites in Japan. The BA program consists of seven sessions. Outcome measures will be evaluated at three times in the intervention group; at the entry, at the end of the intervention and 4 months after the end of the intervention and four times in the waiting group: at the entry, before the intervention, at the end of the intervention, and 4 months after the end of the intervention. Primary outcome is Beck Depression Inventory-II (BDI-II) score. To examine the main effect of the intervention, two-way repeated measures analysis of variance (ANOVA) will be conducted, with timing and intervention status as the independent variables and BDI-II score as the dependent variable. One-way repeated measures ANOVA will be conducted to combine data from the intervention and control groups and examine changes in BDI-II scores by timing in both groups. Secondary endpoints (anxiety, quality of life, spirituality, degree of behavioral activation, value, and pain) will be evaluated with rating scales. Two-way repeated measures ANOVA will be conducted to examine whether there are differences between the groups before and after the intervention, with timing and intervention status as the independent variables and scores on each rating scale as the dependent variables. DISCUSSION This multicenter randomized controlled trial is the first study to assess the effectiveness of BA on depression in patients with advanced cancer. Our findings will provide evidence about the effectiveness of BA on depression and provide an intervention option that is acceptable and feasible for the treatment of depression in this population. The results of this study will lead to improved mood and rebuilding to regain life purpose and value in this vulnerable population. TRIAL REGISTRATION NUMBER jRCT, jRCT1030210687, Registered 22 March 2022, https://jrct.niph.go.jp/en-latest-detail/jRCT1030210687 .
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Affiliation(s)
- Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuko Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Asao Ogawa
- Department of Psycho-Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba Japan
| | - Emi Igarashi
- Department of Psychiatry, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Japan
| | - Saaya Soejima
- Department of Psycho-Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba Japan
| | - Kotone Hata
- Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-shi, Saitama Japan
| | - Yusuke Utsumi
- Department of Psychiatry, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi Japan
| | - Yuki Mashiko
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Kyoka Ogata
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ayako Kayano
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yuko Yanai
- Department of Psycho-Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Shin-ichi Suzuki
- Faculty of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa-shi, Saitama Japan
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Hughes D, Yardley S, Greenfield P, Rolph M. Delivering mental healthcare to patients with a depressive disorder alongside a life-limiting illness. BJPsych Bull 2023; 47:43-48. [PMID: 34994340 PMCID: PMC10028549 DOI: 10.1192/bjb.2021.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The concurrent assessment and treatment of mental health disorders and palliative illnesses is complex. Affective disorders are more prevalent in people who need palliative care. Identifying the most suitable place of care and multi-professional multidisciplinary teams to provide support can be challenging and bewildering for professionals and patients. Mental health clinicians may be left with a sense of therapeutic nihilism, while palliative care teams can feel limited by the mental health resources available for treating those living with significant physical and mental health needs. We discuss the fictional case of a gentleman with metastatic bowel cancer who has developed symptoms of depressive disorder and identify how taking a pragmatic patient-centred approach can offer a route through potential dilemmas when seeking to provide individualised care based on needs. We used lay person experience alongside our own experiences of novel mechanisms for cross-specialty working in order to direct psychiatric trainees' approaches to such cases.
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Sanchez L, Fernandez N, Calle AP, Ladera V, Casado I, Bayon E, Garcia I, Sahagun AM. Assessing the Expression of Emotions in Breast Cancer Survivors during the Time of Recovery: Perspective from Focus Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9672. [PMID: 35955033 PMCID: PMC9368609 DOI: 10.3390/ijerph19159672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Breast cancer has major public health implications, as it is the most frequent malignant tumor and the leading cause of cancer death in women. Survivors have many needs, including strategies to cope with the associated distress. We explore whether focus groups are useful for nurses to obtain information about the emotional state of breast cancer women, and develop strategies for coping with the stress that this disease entails. A qualitative study was carried out, involving 25 focus groups with 83 women treated for breast cancer, recruited from the local Breast Cancer Association (ALMOM). Four open-ended questions were employed, and 60-min discussions were carried out. They were transcribed, analyzed, coded, and the themes identified. Four major themes emerged, including "complex emotional evolution", "emotional isolation", "lack of information" and "inability to give advice". Women admitted that this disease had been a stressful factor for them, causing emotional (anxiety, irritability, anger or guilt) and cognitive disorders (confusion, lack of concentration, forgetfulness). The use of focus groups in breast cancer survivors allows nurses to evaluate the expression of emotions in these women, and collect and share information about their feelings, thoughts and experiences, so that survivors can cope more easily with the stress related to their illness.
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Affiliation(s)
- Leticia Sanchez
- Department of Nursing and Physical Therapy, Faculty of Nursing, University of Leon, 24071 Leon, Spain
| | - Nelida Fernandez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Faculty of Nursing, University of Leon, 24071 Leon, Spain
| | - Angela P. Calle
- Department of Nursing and Physical Therapy, Faculty of Nursing, University of Leon, 24071 Leon, Spain
| | - Valentina Ladera
- Department of Basic Psychology, Psychobiology and Methodology of Behavioral Sciences, University of Salamanca, 37005 Salamanca, Spain
| | - Ines Casado
- Department of Nursing and Physical Therapy, Faculty of Nursing, University of Leon, 24071 Leon, Spain
| | - Enrique Bayon
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Faculty of Nursing, University of Leon, 24071 Leon, Spain
| | - Isaias Garcia
- Department of Electrical and Systems Engineering. University of Leon, 24071 Leon, Spain
| | - Ana M. Sahagun
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Faculty of Nursing, University of Leon, 24071 Leon, Spain
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Amaral RI, Weston FCL, Hirakata VN, Paz AA, Wesner AC. Effectiveness and Efficacy of Therapeutic Interventions Performed by Nurses for Anxiety Disorders: A Systematic Review. J Am Psychiatr Nurses Assoc 2022; 28:283-294. [PMID: 34979827 DOI: 10.1177/10783903211068105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Anxiety disorders are characterized by excessive anxiety, fear, and behavioral disorders that can lead the individual to have losses in daily, social, and work activities, generating a negative impact on their quality of life. AIM: To evaluate the quality of evidence of the therapeutic interventions performed by nurses for anxiety disorders. METHOD: An analysis of the quality of evidence was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The systematic review protocol was registered in the Prospective Register of Systematic Reviews (Prospero), CRD420202939. RESULTS: The interventions performed by nurses were effective (d = 0.44), with significant improvement in reducing anxiety levels, reducing drug use, and improving self-control. CONCLUSIONS: The study indicates that therapeutic interventions performed by nurses are beneficial for individuals who suffer from anxiety disorders, with significant improvement in reducing anxiety levels, reducing medication use, improving self-control, and remission of anxiety symptoms.
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Affiliation(s)
- Roslaine Ifran Amaral
- Roslaine Ifran Amaral, Federal University of Health Sciences, Porto Alegre, RS, Brasil
| | | | - Vânia Naomi Hirakata
- Vânia Naomi Hirakata, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Adriana Aparecida Paz
- Adriana Aparecida Paz, Federal University of Health Sciences, Porto Alegre, RS, Brasil
| | - Ana Cristina Wesner
- Ana Cristina Wesner, Federal University of Health Sciences, Porto Alegre, RS, Brasil
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8
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Huynh NTT, Fan SY, Kao CY. Nurse-led educational interventions for anxiety management in cancer survivors: a systematic review and meta-analysis. Support Care Cancer 2022; 30:6699-6744. [PMID: 35524145 DOI: 10.1007/s00520-022-07085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE This systematic review and meta-analysis was aimed toward evaluating the effectiveness of nurse-led educational interventions in anxiety management in cancer survivors. METHODS The electronic databases including Embase, PubMed, CINAHL Complete, the Cochrane Central Register of Controlled Trials (CENTRAL), and ERIC and manual search were subjected to a systematic search from 2000 to March 2021. A systematic review and meta-analysis was conducted. RESULTS A total of 1028 studies were identified through five electronic databases and manual search. Overall, 42 studies were included in this systematic review. In addition, 32 included studies also investigated the interventional effects in management of depression. Therefore, depression was set as the secondary outcome. The meta-analysis of 20 randomized controlled trials with 2936 participants showed that nurse-led educational interventions decreased cancer survivors' anxiety with a moderate effect size (ES: - 0.25; 95% CI, - 0.35 to - 0.15, p = 0.03). The meta-analysis of 15 studies with 1906 participants indicated that nurse-led educational interventions decreased cancer survivors' depression with a moderate effect size (ES: - 0.33; 95% CI, - 0.45 to - 0.21, p = 0.09). CONCLUSION Evidence supports the effectiveness of nurse-led educational interventions for reducing anxiety and depression in cancer survivors. An individual approach, the combination of face-to-face interventions and materials, a duration of 6 months, and a maximum of 60 min for each session could be considered in the future when developing educational interventions to manage anxiety.
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Affiliation(s)
- Nhien Thi Thuy Huynh
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, Taiwan, 70101
| | - Shu-Yi Fan
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, Taiwan, 70101
| | - Chi-Yin Kao
- Department of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, Taiwan, 70101.
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9
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Loughan AR, Willis KD, Braun SE, Rodin G, Lanoye A, Davies AE, Svikis D, Mazzeo S, Malkin M, Thacker L. Managing cancer and living meaningfully (CALM) in adults with malignant glioma: a proof-of-concept phase IIa trial. J Neurooncol 2022; 157:447-456. [PMID: 35437687 PMCID: PMC9909556 DOI: 10.1007/s11060-022-03988-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Managing Cancer and Living Meaningfully (CALM) is an evidence-based, brief, semi-structured psychotherapy designed to help patients with advanced cancer cope with the practical and profound challenges of their illness. However, no study to date has investigated its feasibility, acceptability, and preliminary effectiveness in adults with malignant glioma, despite the well-documented incidence of psychological distress in this vulnerable and underserved population. METHODS Fourteen patients with glioma and elevated symptoms of depression and/or death anxiety enrolled in the trial: 83% glioblastoma, 75% female, Mage = 56 years (SD = 15.1; range = 27-81). Feasibility was assessed based on established metrics. Acceptability was measured by post-session surveys and post-intervention interviews. Preliminary intervention effects were explored using paired t-tests, comparing psychological distress at baseline and post-intervention. RESULTS Of the 14 enrolled patients, 12 were evaluable. Nine completed the study (75% retention rate). Three patients withdrew due to substantial disease progression which affected their ability to participate. Participants reported high perceived benefit, and all recommended the program to others. Baseline to post-intervention assessments indicated reductions in death anxiety, generalized anxiety, and depression, and increases in spirituality. Quality of life and fear of cancer recurrence remained stable throughout the study period. CONCLUSIONS CALM appears feasible for use with adults with malignant glioma. Enrollment and retention rates were high and comparable to psychotherapy trials for patients with advanced cancer. High perceived benefit and reductions in symptoms of death anxiety, generalized anxiety, and depression were reported by participants. These findings are extremely encouraging and support further study of CALM in neuro-oncology. TRIAL REGISTRATION NUMBER NCT04646213 registered on 11/27/2020.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
- Massey Cancer Center, Richmond, VA, USA.
- Division of Neuro-Oncology, Department of Neurology, Virginia Commonwealth University, School of Medicine, VCU Massey Cancer Center, 1201 East Marshall St, Richmond, VA, 23298-0037, USA.
| | - Kelcie D Willis
- Massey Cancer Center, Richmond, VA, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Sarah Ellen Braun
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Gary Rodin
- Princess Margaret Cancer Center, Toronto, Canada
| | - Autumn Lanoye
- Massey Cancer Center, Richmond, VA, USA
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandria E Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dace Svikis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Suzanne Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Malkin
- Department of Neurology, School of Medicine, Virginia Commonwealth University, 1201 East Marshall St, Richmond, VA, 23298-0037, USA
- Massey Cancer Center, Richmond, VA, USA
| | - Leroy Thacker
- Massey Cancer Center, Richmond, VA, USA
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Venkataramu VN, Ghotra HK, Chaturvedi SK. Management of psychiatric disorders in patients with cancer. Indian J Psychiatry 2022; 64:S458-S472. [PMID: 35602367 PMCID: PMC9122176 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Santosh K Chaturvedi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.,Leicestershire Partnership NHS Trust, Thurmaston, Leicestershire, UK E-mail:
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11
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Nursing, psychotherapy and advanced cancer: A scoping review. Eur J Oncol Nurs 2021; 56:102090. [PMID: 35026499 DOI: 10.1016/j.ejon.2021.102090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Many individuals with advanced cancer have unmet psychological needs and often lack access to supportive care. Psychotherapy for adults with advanced cancer is a promising way to address some of the challenges in meeting these care needs. Nurses are the largest cohort of healthcare workers who can practice as psychotherapists and are positioned ideally to integrate these interventions as part of routine care. The purpose of this scoping review is to map the literature on psychotherapeutic interventions among adults with advanced cancer and to explore the nursing role in this body of evidence. METHODS We conducted a scoping review for relevant quantitative, qualitative, and mixed methods studies. The content of included studies was analyzed and grouped based on two broad categories that describe how nursing's role was mentioned, described, and utilized: 1. Nurses are not the interventionist/psychotherapist and, 2. Nurses are mentioned as the interventionist/psychotherapist. RESULTS Eighty-six studies were included. Overall, majority of studies did not mention a role for nursing in any capacity. Some studies mentioned a non-interventionist role for nursing in the research study. Fourteen studies mentioned nurses as interventionists/psychotherapists. These studies focused on feasibility, acceptability and patient related outcomes of brief psychotherapies. Dignity therapy was the most common psychotherapy in studies where nurses were utilized as interventionists, followed by life review and supportive expressive therapies. Very few studies discussed nursing's role in this area and nursing's capacity to deliver this form of care. CONCLUSION There is paucity in nursing research focused on psychotherapy for adults with advanced cancer. It is feasible and acceptable for nurses to deliver brief psychotherapies to adults with advanced cancer, and the integration of these techniques in everyday practice has great potential that must be explored. The development of this knowledge base is needed to support future education, research, and practice policy agendas.
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Murphy M, Newby J, Butow P, Joubert A, Kirsten L, Shaw J, Shepherd H, Andrews G. A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy ( iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety. Internet Interv 2021; 26:100449. [PMID: 34504779 PMCID: PMC8416957 DOI: 10.1016/j.invent.2021.100449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Evaluate the feasibility, acceptability and potential efficacy of a form of online therapy for clinical depression and/or anxiety in people living with advanced cancer. METHODS A single-arm open trial of a six-lesson clinician-supervised, internet-delivered cognitive behavioural therapy (iCBT) transdiagnostic intervention (iCanADAPT Advanced) was undertaken. Qualitative (semi-structured telephone interview conducted at 3-months) and quantitative data (questionnaires collected at pre-, post-, and 3-month follow-up) were analysed. RESULTS 27 participants partook (26 women, 56% breast cancer, mean age 56yo; average number of mental health diagnoses 1.8, with majority (81%) meeting criteria for generalised anxiety disorder). Feasibility - Unanticipated numbers (48%) of participants had physical health deterioration (cancer progression or death). iCBT had high adherence overall (completion rates: 37% did 6 lessons; 70% did 4 lessons) but adherence was higher for those whose cancer remained stable (completion rates: 43% did 6 lessons; 85% did 4 lessons). Acceptability - the intervention was acceptable to the majority of participants, with high treatment satisfaction. Advisory data was achieved regarding future versions. Potential efficacy - regardless of physical health status, participants who completed the iCBT showed a significant decrease over time in anxiety and depression symptoms. CONCLUSIONS Online therapies may be useful in assisting those living with advanced cancer dealing with clinical depression and anxiety disorders. The specific modality of clinician supervised iCBT has significant potential to be a suitable modality of online therapy.
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Affiliation(s)
- M.J. Murphy
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- Corresponding author.
| | - J.M. Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
- School of Psychology, UNSW, NSW 2052, Australia
| | - P. Butow
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - A. Joubert
- School of Psychology, UNSW, NSW 2052, Australia
| | - L. Kirsten
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
- Nepean Cancer Care Centre, NSW 2747, Australia
| | - J. Shaw
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - H.L. Shepherd
- Psycho-oncology Co-operative Research Group (PoCoG), The University of Sydney, NSW 2006, Australia
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), UNSW, Sydney, NSW 2010, Australia
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13
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Tailoring Cognitive Behavioral Therapy for Depression and Anxiety Symptoms in Mexican Terminal Cancer Patients: A Multiple Baseline Study. J Clin Psychol Med Settings 2021; 27:54-67. [PMID: 31006080 DOI: 10.1007/s10880-019-09620-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to assess the effect of tailored cognitive behavioral therapy (CBT) on depression and anxiety symptoms present in Mexican terminal cancer patients. A non-concurrent multiple baseline design was used across individuals. Nine patients participated in the study, each receiving four to six therapy sessions. The effect size of the intervention range (NAP and Tau indexes) in the nine patients indicates that CBT intervention resulted in weak to moderate impact for anxiety and depression symptoms in this population. The overall standardized mean difference is also moderate, with a reduction of 0.54 and 0.76 standard deviations in depression and anxiety symptoms, respectively. This study provides initial evidence to support a positive effect from CBT on patients with terminal cancer and with mood disorders when facing their impending death.
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Hajibabaei M, Kajbaf B, Esmaeili M, Harirchian MH, Montazeri A. Impact of an Existential-Spiritual Intervention Compared with a Cognitive-Behavioral Therapy on Quality of Life and Meaning in Life among Women with Multiple Sclerosis. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:322-330. [PMID: 33240382 PMCID: PMC7610069 DOI: 10.18502/ijps.v15i4.4298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Multiple sclerosis (MS) is a chronic neurological disease that could aggressively affect patients’ quality of life in most instances. This study aimed to compare the effectiveness of an existential-spiritual psychotherapy with a cognitive-behavioral therapy on quality of life and meaning in life in women with multiple sclerosis. Method: A convenience sample of 43 women with multiple sclerosis participated in this quasi-experimental study. They were randomly assigned into 3 groups: an existential-spiritual intervention, a cognitive-behavioral intervention, and the control group. Participants were assessed for outcome measures (quality of life and meaning in life) at 3 points in time: pretest, posttest, and 5-months follow-up. The Multiple Sclerosis Quality of Life-54 (MSQOL-54) and the Meaning in Life Questionnaires (MLQ) were used as outcome measures. To compare outcomes among the study groups, repeated measures analysis of variance was performed. Results: The results showed that while no difference was observed for the control group, scores for meaning in life improved significantly for existential-spiritual intervention and cognitive-behavioral therapy (p = 0.027, p = 0.039). Also, both mental (p < 0.001, p = 0.014) and physical (p = 0.001, p = 0.013) health dimensions of quality of life increased significantly in the 2 intervention groups. However, the results indicated that women in the existential-spiritual intervention group showed greater improvement in some aspects of meaning in life (search for meaning) and quality of life (role physical and role emotional, pain and energy) compared to women in the cognitive-behavioral intervention group. However, the latter group showed better improvements on 2 subscales (physical function and health distress). Conclusion: Both existential-spiritual and cognitive-behavioral interventions can improve quality of life and meaning in life among women with multiple sclerosis. However, the findings suggest that although both interventions were effective, the existential-spiritual intervention resulted in more positive improvements in some aspects of meaning in life and quality of life.
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Affiliation(s)
- Marzieh Hajibabaei
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.,Psychosomatic Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Kajbaf
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Maryam Esmaeili
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran.,School of Humanity Sciences, University of Science and Culture, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
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15
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Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Tookman A, Mannix K, Gola A, Davis S, Wood J, Jones L. Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT. Health Technol Assess 2020; 23:1-106. [PMID: 31097078 DOI: 10.3310/hta23190] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND With a prevalence of up to 16.5%, depression is one of the commonest mental disorders in people with advanced cancer. Depression reduces the quality of life (QoL) of patients and those close to them. The National Institute for Health and Care Excellence (NICE) guidelines recommend treating depression using antidepressants and/or psychological treatments, such as cognitive-behavioural therapy (CBT). Although CBT has been shown to be effective for people with cancer, it is unclear whether or not this is the case for people with advanced cancer and depression. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of treatment as usual (TAU) plus manualised CBT, delivered by high-level Improving Access to Psychological Therapy (IAPT) practitioners, versus TAU for people with advanced cancer and depression, measured at baseline, 6, 12, 18 and 24 weeks. DESIGN Parallel-group, single-blind, randomised trial, stratified by whether or not an antidepressant was prescribed, comparing TAU with CBT plus TAU. SETTING Recruitment took place in oncology, hospice and primary care settings. CBT was delivered in IAPT centres or/and over the telephone. PARTICIPANTS Patients (N = 230; n = 115 in each arm) with advanced cancer and depression. Inclusion criteria were a diagnosis of cancer not amenable to cure, a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) diagnosis of depressive disorder using the Mini-International Neuropsychiatric Interview, a sufficient understanding of English and eligibility for treatment in an IAPT centre. Exclusion criteria were an estimated survival of < 4 months, being at high risk of suicide and receiving, or having received in the last 2 months, a psychological intervention recommended by NICE for treating depression. INTERVENTIONS (1) Up to 12 sessions of manualised individual CBT plus TAU delivered within 16 weeks and (2) TAU. OUTCOME MEASURES The primary outcome was the Beck Depression Inventory, version 2 (BDI-II) score at 6, 12, 18 and 24 weeks. Secondary outcomes included scores on the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, satisfaction with care, EuroQol-5 Dimensions and the Client Services Receipt Inventory, at 12 and 24 weeks. RESULTS A total of 80% of treatments (185/230) were analysed: CBT (plus TAU) (n = 93) and TAU (n = 92) for the BDI-II score at all time points using multilevel modelling. CBT was not clinically effective [treatment effect -0.84, 95% confidence interval (CI) -2.76 to 1.08; p = 0.39], nor was there any benefit for other measures. A subgroup analysis of those widowed, divorced or separated showed a significant effect of CBT on the BDI-II (treatment effect -7.21, 95% CI -11.15 to -3.28; p < 0.001). Economic analysis revealed that CBT has higher costs but produces more quality-adjusted life-years (QALYs) than TAU. The mean service costs for participants (not including the costs of the interventions) were similar across the two groups. There were no differences in EQ-5D median scores at baseline, nor was there any advantage of CBT over TAU at 12 weeks or 24 weeks. There was no statistically significant improvement in QALYs at 24 weeks. LIMITATIONS Although all participants satisfied a diagnosis of depression, for some, this was of less than moderate severity at baseline, which could have attenuated treatment effects. Only 64% (74/115) took up CBT, comparable to the general uptake through IAPT. CONCLUSIONS Cognitive-behavioural therapy (delivered through IAPT) does not achieve any clinical benefit in advanced cancer patients with depression. The benefit of CBT for people widowed, divorced or separated is consistent with other studies. Alternative treatment options for people with advanced cancer warrant evaluation. Screening and referring those widowed, divorced or separated to IAPT for CBT may be beneficial. Whether or not improvements in this subgroup are due to non-specific therapeutic effects needs investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN07622709. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 19. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Marc Serfaty
- Division of Psychiatry, University College London, London, UK.,Priory Hospital North London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care & Population Health, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Stirling Moorey
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Trefor Aspden
- Division of Psychiatry, University College London, London, UK
| | - Adrian Tookman
- Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
| | - Kathryn Mannix
- Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anna Gola
- Research Department of Primary Care & Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Sarah Davis
- Division of Psychiatry, University College London, London, UK.,Palliative Care Service, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John Wood
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Division of Psychiatry, University College London, London, UK.,Marie Curie Hospice, Royal Free Hampstead NHS Trust, London, UK
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16
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Park T, Hegadoren K, Workun B. Working at the Intersection of Palliative End-of-Life and Mental Health Care: Provider Perspectives. J Palliat Care 2020; 37:183-189. [PMID: 32808560 DOI: 10.1177/0825859720951360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients. METHOD Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis. RESULTS The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not. SIGNIFICANCE OF RESULTS Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.
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Affiliation(s)
- Tanya Park
- Faculty of Nursing, 3158University of Alberta, Edmonton, Canada
| | - Kathy Hegadoren
- Faculty of Nursing, 3158University of Alberta, Edmonton, Canada
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17
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Serfaty M, King M, Nazareth I, Moorey S, Aspden T, Mannix K, Davis S, Wood J, Jones L. Effectiveness of cognitive-behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial. Br J Psychiatry 2020; 216:213-221. [PMID: 31566164 DOI: 10.1192/bjp.2019.207] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Depression is one of the most common mental disorders in people with advanced cancer. Although cognitive-behavioural therapy (CBT) has been shown to be effective for depression in people with cancer, it is unclear whether this is the case for people with advanced cancer and depression. AIMS We sought to determine whether CBT is more clinically effective than treatment as usual (TAU) for treating depression in people with advanced cancer (trial registration number ISRCTN07622709). METHOD A multi-centre, parallel-group single-blind randomised controlled trial comparing TAU with CBT (plus TAU). Participants (n = 230) with advanced cancer and depression were randomly allocated to (a) up to 12 sessions of individual CBT or (b) TAU. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, and Satisfaction with Care. RESULTS Multilevel modelling, including complier-average intention-to-treat analysis, found no benefit of CBT. CBT delivery was proficient, but there was no treatment effect (-0.84, 95% CI -2.76 to 1.08) or effects for secondary measures. Exploratory subgroup analysis suggested an effect of CBT on the BDI-II in those widowed, divorced or separated (-7.21, 95% CI -11.15 to -3.28). CONCLUSIONS UK National Institute for Health and Care Excellence (NICE) guidelines recommend CBT for treating depression. Delivery of CBT through the Improving Access to Psychological Therapies (IAPT) programme has been advocated for long-term conditions such as cancer. Although it is feasible to deliver CBT through IAPT proficiently to people with advanced cancer, this is not clinically effective. CBT for people widowed, divorced or separated needs further exploration. Alternate models of CBT delivery may yield different results.
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Affiliation(s)
- Marc Serfaty
- Associate Professor in Psychiatry, Division of Psychiatry, University College London, UK
| | - Michael King
- Professorial Research Associate, Division of Psychiatry, University College London, UK
| | - Irwin Nazareth
- Professor of Primary Care and Population Science, Research Department of Primary Care and Population Health, University College London, UK
| | - Stirling Moorey
- Consultant Psychiatrist in CBT, South London and Maudsley NHS Foundation Trust, King's College London, UK
| | - Trefor Aspden
- Senior Research Associate, Division of Psychiatry, University College London, UK
| | - Kathryn Mannix
- Consultant in Palliative Medicine and Cognitive Behaviour Therapist, Palliative Care Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Sarah Davis
- Senior Research Nurse, Marie Curie Palliative Care Research Department, University College London, UK
| | - John Wood
- Principle Research Associate, Research Department of Primary Care and Population Health, University College London, UK
| | - Louise Jones
- Honorary Clinical Senior Lecturer, Marie Curie Palliative Care Research Department, University College London, UK
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18
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Rodin G, An E, Shnall J, Malfitano C. Psychological Interventions for Patients With Advanced Disease: Implications for Oncology and Palliative Care. J Clin Oncol 2020; 38:885-904. [PMID: 32023159 DOI: 10.1200/jco.19.00058] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A growing body of research demonstrates the feasibility and efficacy of psychological interventions for adult patients with advanced cancer. Findings from quantitative studies of psychotherapeutic interventions with primary psychological outcomes for such patients are reviewed here and recommendations for best practice are made. We consider these interventions according to three broad phases in which they are most commonly applied: soon after diagnosis of advanced cancer, when living with the disease, and at or near the end of life. Cumulative evidence from well-designed studies demonstrates the efficacy of psychosocial interventions for patients with advanced disease to relieve and prevent depression, anxiety, and distress related to dying and death, as well as to enhance the sense of meaning and preparation for end of life. Individual and couple-based interventions have been proven to be most feasible, and the development and use of tailored and validated measures has enhanced the rigor of research and clinical care. Palliative care nurses and physicians can be trained to deliver many such interventions, but a core of psychosocial clinicians, including social workers, psychologists, and psychiatrists, is usually required to train other health professionals in their delivery and to ensure their quality. Few of the interventions for which there is evidence of effectiveness have been routinely incorporated into oncology or palliative care. Advocacy on the basis of this evidence is required to build psychosocial resources in cancer treatment settings and to ensure that psychological care receives the same priority as other aspects of palliative care in oncology.
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Affiliation(s)
- Gary Rodin
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Ekaterina An
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Joanna Shnall
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Carmine Malfitano
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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19
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Kozlov E, Dong X, Kelley AS, Ankuda CK. The Epidemiology of Depressive Symptoms in the Last Year of Life. J Am Geriatr Soc 2020; 68:321-328. [PMID: 31691265 PMCID: PMC7899291 DOI: 10.1111/jgs.16197] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study's objectives were to document the epidemiology of depressive symptoms in the year prior to death and to assess how the trajectory of depressive symptoms varies by sociodemographic and clinical factors. DESIGN Observational, cross-sectional, cohort study using the Health and Retirement Study. SETTING Population-based survey. PARTICIPANTS A total of 3274 individuals who died within 12 months after assessment. MEASURES Primary outcome: eight-item Center for Epidemiologic Studies Depression Scale (CESD-8). Covariates included sociodemographics, self-reported illnesses, and activity of daily living (ADL) limitations. RESULTS Average CESD-8 score increased over the last year of life, with 59.3% screening positive for depression in the last month before death. Depression symptoms increased gradually from 12 to 4 months before death (increase of 0.05 points/month; 95% confidence interval [CI] = 0.01-0.08 points/month) and then escalated from 4 to 1 months before death (increase of 0.29 points/month; 95% CI = 0.16-0.39 points/month). Women, younger adults, and nonwhite adults all demonstrated higher rates of depressive symptoms. Individuals with cancer reported escalating rates of depressive symptoms at the end of life, while individuals with lung disease and ADL impairment demonstrated persistently high rates throughout the year before death. CONCLUSIONS This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan. J Am Geriatr Soc 68:321-328, 2020.
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Affiliation(s)
- Elissa Kozlov
- Institute for Health, Health Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - XinQi Dong
- Institute for Health, Health Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Geriatric Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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20
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Eways KR, Bennett KK, Hamilton JL, Harry KM, Marszalek J, Marsh MJO, Wilson EJ. Development and Psychometric Properties of the Self-Blame Attributions for Cancer Scale. Oncol Nurs Forum 2020; 47:79-88. [PMID: 31845915 DOI: 10.1188/20.onf.79-88] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To adapt the Cardiac Self-Blame Attributions Scale into the Self-Blame Attributions for Cancer Scale (SBAC) for use in patients with cancer and analyze its psychometric properties. SAMPLE & SETTING 113 patients receiving radiation therapy at the University of Kansas Cancer Center. METHODS & VARIABLES The SBAC and other self-report measures were administered during outpatient oncology appointments for radiation therapy to establish the psychometric properties of the SBAC. RESULTS A two-factor structure represented behavioral and characterological self-blame attributions. Reliability estimates for each factor were excellent and evidence of convergent and discriminant validity was found, indicating support for the SBAC as a valid and reliable measure of self-blame attributions in patients with cancer. IMPLICATIONS FOR NURSING The SBAC may help healthcare providers, including nursing staff, to identify the self-blame patterns exhibited by patients with cancer. Future research can assess the reliability and validity of SBAC across stages of treatment and establish the predictive validity of the scale in individuals with cancer.
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21
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den Boer K, de Veer AJE, Schoonmade LJ, Verhaegh KJ, van Meijel B, Francke AL. A systematic review of palliative care tools and interventions for people with severe mental illness. BMC Psychiatry 2019; 19:106. [PMID: 30943927 PMCID: PMC6446277 DOI: 10.1186/s12888-019-2078-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group. METHODS Systematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors. RESULTS Four studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multi-component intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care. CONCLUSIONS Studies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
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Affiliation(s)
- Karin den Boer
- Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
| | - Anke J. E. de Veer
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands
| | - Linda J. Schoonmade
- 0000 0004 1754 9227grid.12380.38Medical Library, VU University Amsterdam, Amsterdam, the Netherlands
| | - Kim J. Verhaegh
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands
| | - Berno van Meijel
- 0000 0004 0435 165Xgrid.16872.3aAmsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands ,grid.448984.dInholland University of Applied Sciences, Amsterdam, the Netherlands ,Parnassia Psychiatric Institute, The Hague, the Netherlands ,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
| | - Anneke L. Francke
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health Research Institute (APH), VU University Medical Center, Department of Public and Occupational Health, Amsterdam, the Netherlands ,0000 0004 0435 165Xgrid.16872.3aExpertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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Smyth JM, Johnson JA, Auer BJ, Lehman E, Talamo G, Sciamanna CN. Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial. JMIR Ment Health 2018; 5:e11290. [PMID: 30530460 PMCID: PMC6305886 DOI: 10.2196/11290] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Positive affect journaling (PAJ), an emotion-focused self-regulation intervention, has been associated with positive outcomes among medical populations. It may be adapted for Web-based dissemination to address a need for scalable, evidence-based psychosocial interventions among distressed patients with medical conditions. OBJECTIVE This study aimed to examine the impact of a 12-week Web-based PAJ intervention on psychological distress and quality of life in general medical patients. METHODS A total of 70 adults with various medical conditions and elevated anxiety symptoms were recruited from local clinics and randomly assigned to a Web-based PAJ intervention (n=35) or usual care (n=35). The intervention group completed 15-min Web-based PAJ sessions on 3 days each week for 12 weeks. At baseline and the end of months 1 through 3, surveys of psychological, interpersonal, and physical well-being were completed. RESULTS Patients evidenced moderate sustained adherence to Web-based intervention. PAJ was associated with decreased mental distress and increased well-being relative to baseline. PAJ was also associated with less depressive symptoms and anxiety after 1 month and greater resilience after the first and second month, relative to usual care. CONCLUSIONS Web-based PAJ may serve as an effective intervention for mitigating mental distress, increasing well-being, and enhancing physical functioning among medical populations. PAJ may be integrated into routine medical care to improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT01873599; https://clinicaltrials.gov/ct2/show/NCT01873599 (Archived by WebCite at http://www.webcitation.org/73ZGFzD2Z).
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Affiliation(s)
- Joshua M Smyth
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States.,Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Jillian A Johnson
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Brandon J Auer
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Giampaolo Talamo
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
| | - Christopher N Sciamanna
- Department of Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, United States
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Sanjida S, McPhail SM, Shaw J, Couper J, Kissane D, Price MA, Janda M. Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses. Psychooncology 2018; 27:2063-2076. [DOI: 10.1002/pon.4794] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Saira Sanjida
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Functioning and Health Research; Metro South Health; Brisbane Australia
| | - Joanne Shaw
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Jeremy Couper
- Mental Health, Justice Health, Alcohol and Drug Services; Canberra Australia
- Academic Unit of Psychiatry & Addiction Medicine; Australian National University Medical School, The Canberra Hospital; Canberra Australia
| | - David Kissane
- Department of Psychiatry; Monash University; Melbourne Australia
| | - Melanie A. Price
- Psycho-oncology Co-operative Research Group, School of Psychology; The University of Sydney; Sydney Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation; Queensland University of Technology; Brisbane Australia
- Centre for Health Services Research; The University of Queensland; Brisbane Australia
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Latter S, Hopkinson JB, Lowson E, Hughes JA, Hughes J, Duke S, Anstey S, Bennett MI, May C, Smith P, Richardson A. Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial. Palliat Med 2018; 32:246-256. [PMID: 28679073 DOI: 10.1177/0269216317715197] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. AIMS To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients' carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. DESIGN Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants' experiences of Cancer Carers Medicines Management and trial procedures. SETTING Community settings in two study sites. PARTICIPANTS Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. RESULTS A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. CONCLUSION Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers' management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research.
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Affiliation(s)
- Sue Latter
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane B Hopkinson
- 2 School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Elizabeth Lowson
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane A Hughes
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jacki Hughes
- 2 School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sue Duke
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Sally Anstey
- 2 School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Michael I Bennett
- 3 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Carl May
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Peter Smith
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- 1 Faculty of Health Sciences, University of Southampton, Southampton, UK.,4 Cancer Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Lloyd-Williams M, Shiels C, Ellis J, Abba K, Gaynor E, Wilson K, Dowrick C. Pilot randomised controlled trial of focused narrative intervention for moderate to severe depression in palliative care patients: DISCERN trial. Palliat Med 2018; 32:206-215. [PMID: 28590157 PMCID: PMC5758926 DOI: 10.1177/0269216317711322] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Depression is poorly detected and sub-optimally managed in palliative care patients, and few trials of psychosocial interventions have been carried out in this group of patients. AIMS A pilot trial to determine the effect of a focused narrative intervention on depression in palliative care patients when used in addition to usual care. DESIGN Patients scoring 10 or higher on Patient Health Questionnaire-9 randomised to focused narrative intervention in addition to usual care or usual care only and followed up at 2, 4 and 6 weeks. A reduction of five points on Patient Health Questionnaire-9 was regarded as clinically significant response to treatment. SETTING/PARTICIPANTS Palliative care patients aged over 18 recruited from hospice day care services - exclusion criteria included an estimated prognosis of 6 weeks or less, cognitive impairment and unable to understand written or spoken English. RESULTS Out of 57 participating patients (71% female), with mean age 65.1 years (range 36-88 years), 33 patients were randomised to the intervention and 24 to usual care only. Mean Patient Health Questionnaire-9 score at baseline was 16.4. Patients receiving intervention had greater reduction in Patient Health Questionnaire-9 score at 6-week follow-up ( p = 0.04). Median survival was 157 days for intervention and 102 days for control group patients ( p = 0.07). CONCLUSION This pilot trial suggests a focused narrative intervention in palliative care patients with moderate to severe depression can reduce depression scores more than usual care alone. Patients receiving intervention appeared to have longer survival. These results support the need for a fully powered trial.
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Affiliation(s)
- Mari Lloyd-Williams
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Christopher Shiels
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Jacqueline Ellis
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Katharine Abba
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Edward Gaynor
- 2 Liverpool Clinical Commissioning Group, Liverpool, UK
| | - Kenneth Wilson
- 3 Division of Psychiatry, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Christopher Dowrick
- 4 Primary Medical Care, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Atkin N, Vickerstaff V, Candy B. 'Worried to death': the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians. BMC Palliat Care 2017; 16:69. [PMID: 29224571 PMCID: PMC5724241 DOI: 10.1186/s12904-017-0245-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/16/2017] [Indexed: 01/06/2023] Open
Abstract
Background Anxiety adversely affects quality of life and is common in adults with advanced life-limiting disease. There are no UK-wide guidelines on the assessment and management of anxiety in this specific population and there is little evidence regarding drug treatments. This study aimed to explore how palliative care physicians assess and manage anxiety in their patients, and to identify barriers encountered. Methods A cross-sectional survey was undertaken of all physicians working in specialist palliative care in the UK who were members of the Association for Palliative Medicine. This was conducted in February 2014 using an online questionnaire. Results The response rate was 23% (230/980) and 61% of respondents were consultants. Most did not use tools to screen for anxiety (87%) and almost all used the clinical interview to diagnose anxiety (99%). Only 8% used psychiatric criteria. Most physicians reported difficulties managing anxiety (93%). Only 33% thought they had adequate training in this area. Most had difficulty accessing psychological and/or psychiatric services (71%, 64% respectively). The majority used a combination of pharmacological and non-pharmacological treatments for anxiety. The most frequently prescribed first-line medications for patients with a prognosis of days to weeks were benzodiazepines (93%), usually lorazepam. The use of benzodiazepines over antidepressants was statistically significant (p < 0.001). For patients with a prognosis of months, antidepressants were most frequently prescribed first-line (60%), significantly more than benzodiazepines (p < 0.001). However, benzodiazepine use was still common in this prognostic group with 47% prescribing it first-line, sometimes in combination with an antidepressant. Conclusion This is the first national survey on the assessment and management of anxiety in palliative care. Findings demonstrate the infrequent use of screening tools, variation in prescribing practice, potentially inappropriate use of benzodiazepines for patients with a prognosis of months, training gaps and poor access to psychological and psychiatric services in the UK. This highlights the need for formal training, further research into the pharmacological management of anxiety in this population and evidence-based national guidance to support clinical decision-making and service development.
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Affiliation(s)
- N Atkin
- Camden, Islington ELiPSe and UCLH & HCA Palliative Care Service, London, UK
| | - V Vickerstaff
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - B Candy
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Burn K, Lee L. Cognitive behavioural therapy in palliative care: evaluation of staff following a foundation level course. Int J Palliat Nurs 2017. [PMID: 28648134 DOI: 10.12968/ijpn.2017.23.6.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathy Burn
- Cognitive Behavioural Therapy Lead and Clinical Nurse Specialist, St Christopher's Hospice, Sydenham, London
| | - Louise Lee
- Specialist Nurse Practitioner, St Barnabas Hospice, Lincolnshire
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Salt S, Mulvaney CA, Preston NJ. Drug therapy for symptoms associated with anxiety in adult palliative care patients. Cochrane Database Syst Rev 2017; 5:CD004596. [PMID: 28521070 PMCID: PMC6481598 DOI: 10.1002/14651858.cd004596.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This is an update of a Cochrane Review first published in 2004 (Issue 1) and previously updated in 2012 (Issue 10). Anxiety is common in palliative care patients. It can be a natural response to the complex uncertainty of having a life-limiting illness or impending death, but it may represent a clinically significant issue in its own right. OBJECTIVES To assess the effectiveness of drug therapy for treating symptoms of anxiety in adults with a progressive life-limiting illness who are thought to be in their last year of life. SEARCH METHODS We ran the searches for this update to May 2016. We searched the CENTRAL, MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), PsychLIT (Silver Platter) and PsycINFO (Ovid). We searched seven trials registers and seven pharmaceutical industry trials registers. We handsearched the conference abstracts of the European Association of Palliative Care. SELECTION CRITERIA Randomised controlled trials which examined the effect of drug therapy for the treatment of symptoms of anxiety in adult palliative care patients, that is, people with a known progressive life-limiting illness that is no longer responsive to curative treatment, including advanced heart, respiratory and neurological diseases (including dementia). Comparator treatments included placebo; another drug therapy or different dose schedule; or a non-drug intervention such as counselling, cognitive behaviour therapies or relaxation therapies. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts to identify potentially relevant papers for inclusion in the review. We sought full-text reports for all papers retained at this stage and two reviews authors independently assessed these for inclusion in the review. We planned to assess risk of bias and extract data including information on adverse events. We planned to assess the evidence using GRADE and to create a 'Summary of findings' table. MAIN RESULTS In this update, we identified 707 potentially relevant papers and of these we sought the full-text reports of 10 papers. On examination of these full-text reports, we excluded eight and two are awaiting classification as we have insufficient information to make a decision. Thus, in this update, we found no studies which met our inclusion criteria. For the original review, we identified, and then excluded, the full-text reports of six potentially relevant studies. For the 2012 update, we sought, and excluded, two full-text reports. Thus, we found no studies that assessed the effectiveness of drugs to treat symptoms of anxiety in palliative care patients. AUTHORS' CONCLUSIONS There is a lack of evidence to draw a conclusion about the effectiveness of drug therapy for symptoms of anxiety in adult palliative care patients. To date, we have found no studies that meet the inclusion criteria for this review. We are awaiting further information for two studies which may be included in a future update. Randomised controlled trials which assess management of anxiety as a primary endpoint are required to establish the benefits and harms of drug therapy for the treatment of anxiety in palliative care.
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Affiliation(s)
| | | | - Nancy J Preston
- Lancaster UniversityInternational Observatory on End of Life CareFurness CollegeLancasterUKLA1 4YG
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Watson M, Dunn J. The multidisciplinary art and science of cancer care: integrating psycho-oncology. Future Oncol 2016; 12:2775-2778. [DOI: 10.2217/fon-2016-0374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Maggie Watson
- Pastoral & Psychological Care, Compton House, The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jeffrey Dunn
- Cancer Council Queensland, Australia
- School of Public Health, Griffith University, Brisbane, Australia
- School of Social Science, University of Queensland, Australia
- Institute of Resilient Regions, USQ, Australia
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Singer AE, Goebel JR, Kim YS, Dy SM, Ahluwalia SC, Clifford M, Dzeng E, O'Hanlon CE, Motala A, Walling AM, Goldberg J, Meeker D, Ochotorena C, Shanman R, Cui M, Lorenz KA. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med 2016; 19:995-1008. [PMID: 27533892 PMCID: PMC5011630 DOI: 10.1089/jpm.2015.0367] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.
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Affiliation(s)
- Adam E. Singer
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
| | - Joy R. Goebel
- School of Nursing, California State University, Long Beach, Long Beach, California
| | - Yan S. Kim
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Elizabeth Dzeng
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, California
| | - Claire E. O'Hanlon
- RAND Corporation, Santa Monica, California
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California
| | | | - Anne M. Walling
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jaime Goldberg
- Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniella Meeker
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | | | - Mike Cui
- RAND Corporation, Pittsburgh, Pennsylvania
| | - Karl A. Lorenz
- RAND Corporation, Santa Monica, California
- Stanford University School of Medicine, Stanford, California
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Tan SB, Loh EC, Lam CL, Ng CG, Lim EJ, Boey CCM. Psychological processes of suffering of palliative care patients in Malaysia: a thematic analysis. BMJ Support Palliat Care 2016; 9:e19. [PMID: 27098972 DOI: 10.1136/bmjspcare-2015-001064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/25/2016] [Accepted: 04/04/2016] [Indexed: 11/04/2022]
Abstract
Although suffering in palliative care has received increasing attention over the past decade, the psychological processes that underpin suffering remain relatively unexplored. OBJECTIVE To understand the psychological processes involved in the experiencing of suffering at the end phase of life. METHODS Semistructured interviews were conducted with 20 palliative care inpatients from an academic medical centre in Kuala Lumpur, Malaysia. The transcripts were thematically analysed with NVIVO9. RESULTS 5 themes of psychological processes of suffering were generated: (1) perceptions, (2) cognitive appraisals, (3) hope and the struggles with acceptance, (4) emotions and (5) clinging. A model of suffering formation was constructed. CONCLUSION The findings may inform the development of mechanism-based interventions in the palliation of suffering.
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Affiliation(s)
- Seng Beng Tan
- Unit of Palliative Medicine, Faculty of Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ee Chin Loh
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ee Jane Lim
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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Serfaty M, King M, Nazareth I, Tookman A, Wood J, Gola A, Aspden T, Mannix K, Davis S, Moorey S, Jones L. The clinical and cost effectiveness of cognitive behavioural therapy plus treatment as usual for the treatment of depression in advanced cancer (CanTalk): study protocol for a randomised controlled trial. Trials 2016; 17:113. [PMID: 26926910 PMCID: PMC4772591 DOI: 10.1186/s13063-016-1223-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/09/2016] [Indexed: 01/02/2023] Open
Abstract
Background The prevalence of depressive disorder in adults with advanced cancer is around 20 %. Although cognitive behavioural therapy (CBT) is recommended for depression and may be beneficial in depressed people with cancer, its use for depression in those with advanced disease for whom cure is not likely has not been explored. Methods People aged 18 years and above with advanced cancer attending General Practitioner (GP), oncology or hospice outpatients from centres across England will be screened to establish a DSM-IV diagnosis of depression. Self-referral is also accepted. Eligible consenters will be randomised to a single blind, multicentre, randomised controlled trial of the addition to treatment as usual (TAU) of up to 12 one-hour weekly sessions of manualised CBT versus TAU alone. Sessions are delivered in primary care through Increasing Access to Psychological Care (IAPT) service, and the manual includes a focus on issues for people approaching the end of life. The main outcome is the Beck Depression Inventory-II (BDI-II). Subsidiary measures include the Patient Health Questionnaire, quality of life measure EQ-5D, Satisfaction with care, Eastern Cooperative Oncology Group-Performance Status and a modified Client Service Receipt Inventory. At 90 % power, we require 240 participants to enter the trial. Data will be analysed using multi-level (hierarchical) models for data collected at baseline, 6, 12, 18 and 24 weeks. Cost effectiveness analysis will incorporate costs related to the intervention to compare overall healthcare costs and QALYs between the treatment arms. We will conduct qualitative interviews after final follow-up on patient and therapist perspectives of the therapy. Discussion This trial will provide data on the clinical and cost effectiveness of CBT for people with advanced cancer and depression. We shall gain an understanding of the feasibility of delivering care to this group through IAPT. Our findings will provide evidence for policy-makers, commissioners and clinicians in cancer and palliative care, and in the community. Trial registration Controlled Trials ISRCTN07622709, registered 15 July 2011.
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Affiliation(s)
- Marc Serfaty
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael King
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Irwin Nazareth
- Research Department of Primary Care & Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3 2PF, UK.
| | - Adrian Tookman
- Marie Curie Hospice, 11 Lyndhurst Gardens, London, NW3 5NS, UK. .,Palliative Medicine, Royal Free Hampstead NHS Trust, London, UK.
| | - John Wood
- Research Department of Primary Care & Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3 2PF, UK.
| | - Anna Gola
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Trefor Aspden
- Division of Psychiatry, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Kathryn Mannix
- Palliative Medicine, Newcastle upon Tyne Hospital NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK.
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Stirling Moorey
- Psychotherapy and CBT, South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
| | - Louise Jones
- Marie Curie Palliative Care Research Department, UCL, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Lam KFY, Lim HA, Tan JYS, Mahendran R. The relationships between dysfunctional attitudes, rumination, and non-somatic depressive symptomatology in newly diagnosed Asian cancer patients. Compr Psychiatry 2015; 61:49-56. [PMID: 26112063 DOI: 10.1016/j.comppsych.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/30/2015] [Accepted: 06/01/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Given the high prevalence of cancer patients with comorbid depression, the present study sought to elucidate the relationships between two vulnerability factors, dysfunctional attitudes and rumination, and their influence on non-somatic depressive symptomatology in an Asian cohort of cancer patients. It was hypothesized that all variables of interest would be inter-correlated, and that both dysfunctional attitudes and rumination would mediate one another in influencing non-somatic depressive symptoms. METHODS A total of 194 recently diagnosed mixed-cancer patients in Singapore (Mage=49.2±9.2years; 68% women; 61% ethnically Chinese), without any comorbid psychiatric diagnosis, completed the Dysfunctional Attitudes Scale Form A, Rumination Responses Scale (comprising brooding and reflective rumination), and Hospital Anxiety and Depression Scale. RESULTS Correlational analyses revealed that all variables were inter-correlated (rhos[194]=.35-.52). Bootstrapping mediation analyses controlling for gender and treatment received revealed that both brooding and reflective rumination mediated the relationship between dysfunctional attitudes and non-somatic depressive symptoms, and that dysfunctional attitudes also mediated the relationship between both brooding and reflective rumination and non-somatic depressive symptoms. CONCLUSIONS Findings suggest that, in cancer patients, both dysfunctional attitudes and rumination seem to act upon one other, in a feedback loop, to influence non-somatic depressive symptomatology. Clinicians may therefore have a wider range of treatments to choose from in managing cancer patients with depressive symptomatology.
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Affiliation(s)
- Kevin F Y Lam
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore
| | - Haikel A Lim
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore
| | - Joyce Y S Tan
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore
| | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore; Department of Psychological Medicine, National University Hospital, NUHS Tower Block, Level 9, 1E Kent Ridge Road, 119228, Singapore; Duke-NUS Graduate Medical School Singapore, 8 College Road, 169857, Singapore.
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Taylor-Ford M. Clinical considerations for working with patients with advanced cancer. J Clin Psychol Med Settings 2015; 21:201-13. [PMID: 24916664 DOI: 10.1007/s10880-014-9398-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Advanced cancer is a life-limiting condition, but improvements in medical care are contributing to longer survival among some patients. As a result, it is likely that mental health professionals will be called upon to assist more patients with advanced cancer. The present paper reviews the psychological literature and from it draws clinical considerations for working with individuals affected by advanced cancer. It begins with a brief description of advanced cancer and the medical attributes of an advanced cancer diagnosis, and then catalogues salient medical, psychological, existential, and interpersonal challenges faced by this patient population. The review concludes with recommendations for treatment planning including an overview of some of the more recently tested and widely available interventions. It is hoped that this review will serve as a resource for professionals working with patients affected by advanced cancer.
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Affiliation(s)
- Megan Taylor-Ford
- Department of Psychology, University of Southern California, SGM 501, 3620 South McClintock Ave., Los Angeles, CA, 90089-1061, USA,
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Reich M. Les troubles psychiatriques en soins palliatifs et en fin de vie. Presse Med 2015; 44:442-55. [DOI: 10.1016/j.lpm.2015.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/27/2015] [Accepted: 02/03/2015] [Indexed: 10/23/2022] Open
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Sampaio FMC, Sequeira CADC, Lluch Canut MT. Nursing psychotherapeutic interventions: a review of clinical studies. J Clin Nurs 2015; 24:2096-105. [DOI: 10.1111/jocn.12808] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Francisco Miguel Correia Sampaio
- Instituto de Ciências Biomédicas Abel Salazar; Universidade do Porto; Porto Portugal
- Hospital de Braga-Psychiatry Department; Braga Portugal
- Porto Nursing School; Porto Portugal
| | - Carlos Alberto da Cruz Sequeira
- Porto Nursing School-Scientific Pedagogical Unit “Nursing: Discipline & Profession”; Porto Portugal
- ”NurID: Innovation & Development in Nursing” - CINTESIS-FMUP; Porto Portugal
| | - María Teresa Lluch Canut
- Barcelona University School of Nursing; Department of Public Health and Perinatal Nursing; Barcelona Spain
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Drageset J, Corbett A, Selbaek G, Husebo BS. Cancer-related pain and symptoms among nursing home residents: a systematic review. J Pain Symptom Manage 2014; 48:699-710.e1. [PMID: 24703946 DOI: 10.1016/j.jpainsymman.2013.12.238] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/14/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022]
Abstract
CONTEXT Many older nursing home (NH) residents with cancer experience pain and distressing symptoms. Although some develop cancer during their time in the institution, an increasing number are admitted during their final stages of their lives. Numerous studies have evaluated various treatment approaches, but how pain and symptoms are assessed and managed in people with cancer with and without dementia is unclear. OBJECTIVES The objective of this review was to summarize the evidence on cancer-related symptoms among NH residents with and without dementia. METHODS We systematically searched the PubMed (1946-2012), Embase (1974-2012), CINAHL (1981-2012), AgeLine, and Cochrane Library (1998-2012) databases using the search terms neoplasms, cancer, tumor, and nursing home. The inclusion criteria were studies including NH residents with a diagnosis of cancer and outcome measures including pain and cancer-related symptoms. RESULTS We identified 11 studies (cross-sectional, longitudinal, clinical trial, and qualitative studies). Ten studies investigated the prevalence and treatment of cancer-related symptoms such as vomiting, nausea, urinary tract infections, and depression. Studies clearly report a high prevalence of pain and reduced prescribing and treatment, regardless of the cognitive status. Only one small study included people with cancer and a diagnosis of dementia. Studies of new cancer diagnoses in NHs could not be identified. CONCLUSION This review clearly reports a high prevalence of pain and reduced drug prescribing and treatment among NH residents with cancer. This issue appears to be most critical among people with severe dementia, emphasizing the need for better guidance and evidence on pain assessment for these individuals.
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Affiliation(s)
- Jorunn Drageset
- Faculty for Health and Social Science, Bergen University College, Bergen, Norway; Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway.
| | - Anne Corbett
- Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom
| | - Geir Selbaek
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway; Akershus University Hospital, Lørenskog, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway; Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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Janberidze E, Hjermstad MJ, Haugen DF, Sigurdardottir KR, Løhre ET, Lie HC, Loge JH, Kaasa S, Knudsen AK. How are patient populations characterized in studies investigating depression in advanced cancer? Results from a systematic literature review. J Pain Symptom Manage 2014; 48:678-98. [PMID: 24681108 DOI: 10.1016/j.jpainsymman.2013.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 11/22/2013] [Accepted: 12/12/2013] [Indexed: 11/25/2022]
Abstract
CONTEXT Prevalence rates of depression in patients with advanced cancer vary considerably. This may be because of heterogeneous samples and use of different assessment methods. Adequate sample descriptions and consistent use of measures are needed to be able to generalize research findings and apply them to clinical practice. OBJECTIVES Our objective was twofold: First, to investigate which clinically important variables were used to describe the samples in studies of depression in patients with advanced cancer; and second, to examine the methods used for assessing and classifying depression in these studies. METHODS PubMed, PsycINFO, Embase, and CINAHL were searched combining search term groups representing "depression," "palliative care," and "advanced cancer" covering 2007-2011. Titles and abstracts were screened, and relevant full-text articles were evaluated independently by two authors. Information on 32 predefined variables on cancer disease, treatment, sociodemographics, depression-related factors, and assessment methods was extracted from the articles. RESULTS After removing duplicates, 916 citations were screened of which 59 articles were retained. Age, gender, and stage of the cancer disease were the most frequently reported variables. Depression-related variables were rarely reported, for example, antidepressant use (17%) and previous depressive episodes (12%). Only 25% of the studies assessed and classified depression according to a validated diagnostic system. CONCLUSION Current practice for describing sample characteristics and assessing depression varies greatly between studies. A more standardized practice is recommended to enhance the generalizability and utility of findings. Stakeholders are encouraged to work toward a common standard for sample descriptions.
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Affiliation(s)
- Elene Janberidze
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Erik Torbjørn Løhre
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Science, Faculty of Medicine, University of Oslo, Oslo, Norway; National Resource Centre for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Sigurdardottir KR, Oldervoll L, Hjermstad MJ, Kaasa S, Knudsen AK, Løhre ET, Loge JH, Haugen DF. How are palliative care cancer populations characterized in randomized controlled trials? A literature review. J Pain Symptom Manage 2014; 47:906-914.e17. [PMID: 24018205 DOI: 10.1016/j.jpainsymman.2013.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/05/2013] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
CONTEXT The difficulties in defining a palliative care patient accentuate the need to provide stringent descriptions of the patient population in palliative care research. OBJECTIVES To conduct a systematic literature review with the aim of identifying which key variables have been used to describe adult palliative care cancer populations in randomized controlled trials (RCTs). METHODS The data sources used were MEDLINE (1950 to January 25, 2010) and Embase (1980 to January 25, 2010), limited to RCTs in adult cancer patients with incurable disease. Forty-three variables were systematically extracted from the eligible articles. RESULTS The review includes 336 articles reporting RCTs in palliative care cancer patients. Age (98%), gender (90%), cancer diagnosis (89%), performance status (45%), and survival (45%) were the most frequently reported variables. A large number of other variables were much less frequently reported. CONCLUSION A substantial variation exists in how palliative care cancer populations are described in RCTs. Few variables are consistently registered and reported. There is a clear need to standardize the reporting. The results from this work will serve as the basis for an international Delphi process with the aim of reaching consensus on a minimum set of descriptors to characterize a palliative care cancer population.
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Affiliation(s)
- Katrin Ruth Sigurdardottir
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Sunniva Centre for Palliative Care, Haraldsplass Deaconess Hospital, Bergen, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway.
| | - Line Oldervoll
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Røros Rehabilitation Centre, Røros, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre for Excellence in Palliative Care, South Eastern Norway, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Kari Knudsen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erik Torbjørn Løhre
- Department of Oncology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jon Håvard Loge
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; National Resource Centre for Late Effects After Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Dagny Faksvåg Haugen
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
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Watson M, Dunn J, Holland JC. Review of the history and development in the field of psychosocial oncology. Int Rev Psychiatry 2014; 26:128-35. [PMID: 24716506 DOI: 10.3109/09540261.2013.849230] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychosocial oncology is a multi-disciplinary field of practice and, as a recently developed speciality, covers the psychological, social and behavioural dimensions of cancer. We describe the historical background and changing ethos in medical practice in order to understand factors that contributed to the emergence of this new discipline. Modern psychosocial oncology covers a number of topics; the diagnosis and management of psychological morbidity and distress across the cancer continuum from diagnosis through survivorship and, for some patients, terminal illness, the recognition that behaviour and lifestyle contribute to cancer risk and prognosis, the need to include families and carers alongside patients in a comprehensive model of supportive cancer care. Best practice, based on evidence and nationally and internationally accepted guidelines, is being integrated into national cancer plans, and services are briefly described. Future challenges include the need to recognize that the behavioural and mental health sciences have a role to play in comprehensive cancer care and that multi-disciplinary care, which includes psychosocial care, is the best model for ensuring patients needs are comprehensively and adequately met. The return of modern medicine to a more holistic person-focused ethos is needed in order to put the patient back into patient-centred cancer care.
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Affiliation(s)
- Maggie Watson
- Royal Marsden NHS Trust/Institute of Cancer Research , Sutton , UK
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Dennison L, Moss-Morris R. Cognitive–behavioral therapy: what benefits can it offer people with multiple sclerosis? Expert Rev Neurother 2014; 10:1383-90. [DOI: 10.1586/ern.10.111] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse 2014; 45:22-32. [PMID: 24099223 DOI: 10.5172/conu.2013.45.1.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nursing research increasingly calls for clinical supervision to support nurses and improve nursing practice. Despite this, clinical supervision is not well established in healthcare organisations. This paper employs a critical interpretive approach to review the clinical supervision literature. The review discusses the current debates and challenges exploring possible ways of moving beyond the current criticisms and limitations in the literature. The review concludes that despite some confusion about the quantifiable outcomes, clinical supervision presents a professionally enriching activity that provides a forum for sharing of knowledge and generation of shared understandings of health care. Through this shared experience it is possible that innovative and creative approaches to health care will be born.
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Affiliation(s)
- Sophie Dilworth
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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Lloyd-Williams M, Payne S, Reeve J, Kolamunnage Dona R. Antidepressant medication in patients with advanced cancer--an observational study. QJM 2013; 106:995-1001. [PMID: 23737506 DOI: 10.1093/qjmed/hct133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Literature reviews suggest limited evidence of efficacy of antidepressant medication in patients with advanced cancer. This study was carried out to observe the longitudinal effect of antidepressant medication in a cohort of advanced cancer patients. METHOD Patients were recruited from hospice day care settings and followed up longitudinally by series of measures for depression for 6 months or until death. RESULTS Six hundred and twenty nine patients recruited. One hundred and fifty six patients in total (25%) were receiving antidepressant medication for a median of 9.5 weeks (range 0-36 weeks) and a mean of 12.2 weeks. There was no significant difference in scores on depression measures over time for patients receiving antidepressant medication. CONCLUSION Antidepressant medication for advanced cancer patients appeared to have little impact on depression scores. We postulate the holistic approaches within hospice day care may in themselves be interventions for depression thereby masking effect of pharmacological treatment. Further research should explore multi-intervention models for management of depression in advanced cancer.
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Affiliation(s)
- Mari Lloyd-Williams
- Professor and Director Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB.
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A pan-Canadian web-based education program to support screening for distress: Evaluation of outcomes. Palliat Support Care 2013; 12:15-23. [DOI: 10.1017/s1478951513000072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Cancer-related distress has been endorsed as the sixth vital sign by many international cancer organizations, and some countries such as Canada have implemented national screening for distress programs. The completion of a screening tool is an important first step in improving responsiveness to cancer-related distress, but screening must be followed with skilled supportive care to make a difference in patient-reported outcomes. Our objective was to create a web-based education program to support nurses and other frontline staff in providing an initial response to screening results.Method:To address screening and supportive care learning needs, the Canadian Association of Psychosocial Oncology (CAPO), with support from the Canadian Partnership Against Cancer, created a web-based education program as one component of the national screening for distress agenda. The program provides clinically grounded and interactive learning through the use of PowerPoint presentations, video clips of clinical interactions with patients and family members, and test questions. Presentation topics include, for example, strategies for dealing with screening results, managing referrals, and supportive counseling. We employed a matched pairs, pre-post survey design to assess the effect of the education program on confidence in screening and in providing initial supportive care.Results:Our analysis of the first 147 matched pairs to complete the course suggests that satisfaction with the course was high. Statistically significant increases in confidence in relation to screening for distress and assessing distress, and in providing initial supportive care, were evident.Significance of results:Our ongoing experience with CAPO's Interprofessional Psychosocial Oncology Distance Education (IPODE) project (www.ipode.ca) project suggests that healthcare professionals value web-based learning for its accessibility and convenience. Such programs appear to offer excellent opportunities for cost-effective education that supports practice change.
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Perceptions of two therapeutic approaches for palliative care patients experiencing death anxiety. Palliat Support Care 2013; 12:251-60. [DOI: 10.1017/s1478951513000199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Evidenced-based psychotherapies are not well researched for palliative care patients experiencing unrelenting anxiety about dying, even less research is focused on young adult palliative care patients with death anxiety. The aim of this study is to provide preliminary data regarding potential clients' perceptions of using evidenced based treatments with dying populations who are experiencing death anxiety.Methods:104 college students were used as potential clients and randomly assigned to watch either a short video of a cognitive therapy (CT) session or of an acceptance and commitment therapy (ACT) session focused on treating a young adult diagnosed with an acute lymphoid leukemia expressing death anxiety. After watching the video, potential clients rated the session impact of the therapy approach using the Session Evaluation Questionnaire.Results:No differences in ratings of session impact were found between potential clients who viewed the CT session and the ACT session. In regards to potential clients' views of session impact variables, their view of session smoothness was positively related to their post-session positivity, but inversely related to their view of session depth. Additionally, a positive correlation was found between potential clients' views of the therapist and session depth.Significance of results:This preliminary study suggests that palliative care patients expressing death anxiety may benefit from either ACT or CT for death anxiety, however, future research is needed to explore the usefulness of each approach. Findings of this study support the theory that ACT and CT are viewed to have a similar session impact in the palliative care population.
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47
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Monroe B, Hansford P. Challenges in delivering palliative care in the community – a perspective from St Christopher's Hospice, London, UK. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/096992610x12624290276115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Moorey S. 'I know they are distressed. What do I do now?'. Psychooncology 2013; 22:1946-52. [PMID: 23813774 DOI: 10.1002/pon.3297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/29/2013] [Indexed: 11/11/2022]
Abstract
Significant advances have been made in our understanding of psychological adjustment to cancer over the last 40 years. Most clinicians now recognise the importance of psychosocial factors and the need for skills in emotional support. In the first phase of psycho-oncology, pioneering work in the 1970s and 1980s mapped the extent of psychological morbidity in cancer. This has been followed by a second phase where clinical trials have demonstrated that psychological treatments are effective. But although clinicians may feel more confident in identifying distress and listening to the patient, they rarely feel confident that they possess the skills to help. This paper will review the progress through the first two phases and argue that we are now in the third phase where we can begin to examine methods for delivering cost-effective psychological care. One of these methods is to equip staff with basic skills to understand and manage psychological distress. This paper will also describe a programme over the last 10 years to evaluate the effectiveness and clinical impact of such training for palliative care professionals.
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Affiliation(s)
- Stirling Moorey
- Institute of Psychiatry, Psychological Medicine, London, UK.
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49
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Meijer A, Roseman M, Delisle VC, Milette K, Levis B, Syamchandra A, Stefanek ME, Stewart DE, de Jonge P, Coyne JC, Thombs BD. Effects of screening for psychological distress on patient outcomes in cancer: a systematic review. J Psychosom Res 2013; 75:1-17. [PMID: 23751231 PMCID: PMC3833882 DOI: 10.1016/j.jpsychores.2013.01.012] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/11/2013] [Accepted: 01/12/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes. METHODS CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO, and SCOPUS databases were searched through April 6, 2011 with manual searches of 45 relevant journals, reference list review, citation tracking of included articles, and trial registry reviews through June 30, 2012. Articles in any language on cancer patients were included if they (1) compared treatment for patients with psychological distress to placebo or usual care in a randomized controlled trial (RCT); or (2) assessed the effect of screening on psychological distress in a RCT. RESULTS There were 14 eligible RCTs for treatment of distress, and 1 RCT on the effects of screening on patient distress. Pharmacological, psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects. One study investigated effects of screening for distress on psychological outcomes, and it found no improvement. CONCLUSION Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening.
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Affiliation(s)
- Anna Meijer
- Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Michelle Roseman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal, Quebéc, Canada
| | - Vanessa C. Delisle
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada
| | - Katherine Milette
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Achyuth Syamchandra
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Michael E. Stefanek
- Office of Research Administration, Indiana University, Bloomington, Indiana, USA
| | - Donna E. Stewart
- Women’s Health Program, University Health Network, Toronto, Ontario, Canada,Departments of Psychiatry, Obstetrics and Gynaecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University of Toronto, Ontario, Canada
| | - Peter de Jonge
- Interdisciplinary Center for Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, The Netherlands
| | - James C. Coyne
- Behavioral Oncology Program, Abramson Cancer Center and Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Health Psychology Section, Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada,Department of Psychiatry, McGill University, Montréal, Quebéc, Canada,Department of Educational and Counselling Psychology, McGill University, Montréal, Quebéc, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Quebéc, Canada,Department of Medicine, McGill University, Montréal, Quebéc, Canada,School of Nursing, McGill University, Montréal, Quebéc, Canada
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Lloyd-Williams M, Cobb M, O'Connor C, Dunn L, Shiels C. A pilot randomised controlled trial to reduce suffering and emotional distress in patients with advanced cancer. J Affect Disord 2013; 148:141-5. [PMID: 23219061 DOI: 10.1016/j.jad.2012.11.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 11/09/2012] [Accepted: 11/10/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A pilot trial was carried out to determine if a focussed narrative interview could alleviate the components of suffering and anxiety and depression in advanced cancer patients. INTERVENTION Patients recruited were invited to participate in a focussed narrative interview and reflect on their perspectives on their sense of "meaning", regarding suffering and their psychological, physical, social and spiritual well being - the emphasis was on allowing the patient to tell their story. Patients were encouraged to share what resources they themselves had utilised in addition to what professional care they may have received, to maintain a sense of well being. METHOD Patients with advanced metastatic disease were recruited from hospices in the North West of England - the only exclusion criteria were not being able to understand written and spoken English and a non cancer diagnosis. At recruitment patients were asked to complete a numerical scale for suffering; the Brief Edinburgh Depression Scale, Edmonton Symptom Assessment Scale (ESAS), FACIT Spiritual well being questionnaire, Demographic information was collected and patients were randomised to either the intervention arm of the trial or the usual care arm of the study. Patients in both groups were invited to complete each measure at 2, 4 and 8 weeks. RESULTS One hundred people were recruited into the study - 49 were randomised to intervention group and 51 to control group. The median age of patients was 66 years age range (31-89 years) and 68% of patients were female. At baseline the ECOG performance of 75% of patients recruited was 1 or 2. The median survival of all patients in the study was 169.5 days (range 10 days to still alive at end of study). There was no significant difference at any timepoint in scores on suffering measure between intervention group and control group. At each time point the intervention demonstrated mean improvement in scores for depression and anxiety on ESAS - the greatest changes for both depression and anxiety were seen at 4 weeks. CONCLUSION This pilot randomised controlled trial of a focussed narrative intervention demonstrated an improvement in mean changes in scores for depression and anxiety at 2, 4, and 8 weeks. We suggest this intervention may have beneficial effects on depression and anxiety, but a larger powered trial is required to determine the full effects.
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Affiliation(s)
- Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society Faculty of Medicine, University of Liverpool Brownlow Hill, Liverpool L69 3GB, United Kingdom.
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