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Banstola A, Pokhrel S, Hayhoe B, Nicholls D, Harris M, Anokye N. Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review. BMJ Open 2023; 13:e069270. [PMID: 36854591 PMCID: PMC9980364 DOI: 10.1136/bmjopen-2022-069270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective. DESIGN A systematic review. DATA SOURCES MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022. ELIGIBILITY CRITERIA We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted. RESULTS A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods. CONCLUSIONS Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions. PROSPERO REGISTRATION NUMBER CRD42022302036.
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Affiliation(s)
- Amrit Banstola
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Subhash Pokhrel
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Nana Anokye
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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2
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Implementing collaborative care for major depression in a cancer center: An observational study using mixed-methods. Gen Hosp Psychiatry 2022; 76:3-15. [PMID: 35305403 DOI: 10.1016/j.genhosppsych.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the implementation of a collaborative care (CC) screening and treatment program for major depression in people with cancer, found to be effective in clinical trials, into routine outpatient care of a cancer center. METHOD A mixed-methods observational study guided by the RE-AIM implementation framework using quantitative and qualitative data collected over five years. RESULTS Program set-up took three years and required more involvement of CC experts than anticipated. Barriers to implementation were uncertainty about whether oncology or psychiatry owned the program and the hospital's organizational complexity. Selecting and training CC team members was a major task. 90% (14,412/16,074) of patients participated in depression screening and 61% (136/224) of those offered treatment attended at least one session. Depression outcomes were similar to trial benchmarks (61%; 78/127 patients had a treatment response). After two years the program obtained long-term funding. Facilitators of implementation were strong trial evidence, effective integration into cancer care and ongoing clinical and managerial support. CONCLUSION A CC program for major depression, designed for the cancer setting, can be successfully implemented into routine care, but requires time, persistence and involvement of CC experts. Once operating it can be an effective and valued component of medical care.
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Sirey JA, Raue PJ, Solomonov N, Scher C, Chalfin A, Zanotti P, Berman J, Alexopoulos GS. Community delivery of brief therapy for depressed older adults impacted by Hurricane Sandy. Transl Behav Med 2021; 10:539-545. [PMID: 32766863 DOI: 10.1093/tbm/ibz145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Older adults frequently under-report depressive symptoms and often fail to access services after a disaster. To address unmet mental health needs, we developed a service delivery program (SMART-MH) that combines outreach, assessment, and therapy and implemented it in New York City after Hurricane Sandy. This study aimed to examine the feasibility, effectiveness, and patients' engagement of our brief psychotherapy ("Engage"). We predicted that Engage would result in reductions of depression, and that the benefits would be comparable to those of a historical comparison group who received Engage in a controlled experimental setting. A total of 2,831 adults (age ≥ 60) impacted by Hurricane Sandy were screened for depression. Assessments and therapy were conducted in English, Spanish, Cantonese, and Russian. Depressed individuals (PHQ-9 ≥ 10) who were not in treatment were offered Engage therapy in their native language at local senior center/nutrition sites. Twelve percent of the participants reported depression (N = 333). Of these 333 participants, 201 (60%) were not receiving treatment and 143 agreed to receive Engage therapy. Linear mixed-effects model showed that depression severity decreased significantly over time. More than two thirds had a five-point reduction in PHQ-9 scores and post-treatment scores ≤9. Post-hoc comparison of standardized slopes of change found patterns of depression reductions equivalent to Engage provided in a controlled setting. Partnerships to integrate mental health care into community settings can increase detection of mental-health needs and access to services in patients' native language. Brief reward exposure-based psychotherapy delivered in the community can provide comparable benefits to those achieved in research settings.
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Affiliation(s)
- Jo Anne Sirey
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Nili Solomonov
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Clara Scher
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Alexandra Chalfin
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Paula Zanotti
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
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Erim DO. Cost-Effectiveness of Providing the Depression Care for People With Cancer Program to Patients With Prostate Cancer in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:216-226. [PMID: 33518028 DOI: 10.1016/j.jval.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The Depression Care for People with Cancer program (DCPC) is a cost-effective depression care model for UK patients with cancer. However, DCPC's cost-effectiveness in the United States is unknown, particularly for patients with prostate cancer in the United States. This study evaluates the health and economic impact of providing DCPC to patients with prostate cancer. METHODS DCPC was compared with usual care in a mathematical model that simulates depression and its outcomes in a hypothetical cohort of US patients with prostate cancer. DCPC was modeled as a sequential combination of universal depression screening, post-screening evaluations, and first-line combination therapy. Primary outcomes were lifetime direct costs of depression care, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Secondary outcomes included life expectancy, number of depression-free months and lifetime depressive episodes, duration of depressive episodes, cumulative incidence of depression, lifetime depression diagnoses/misdiagnoses, and the cumulative incidence of maintenance therapy for depression. Sensitivity analyses were used to examine uncertainty. RESULTS In the base case, DCPC dominated usual care by offering 0.11 more QALYs for $2500 less per patient (from averted misdiagnoses). DCPC also offered 5 extra depression-free months, shorter depressive episodes, and a lower chance of maintenance therapy. DCPC's trade-offs were a higher cumulative incidence of depression and more lifetime depressive episodes. Life expectancy was identical under usual care and DCPC. Sensitivity analyses indicate that DCPC was almost always preferable to usual care. CONCLUSION Compared with usual care, DCPC may offer more value to US patients with prostate cancer. DCPC should be considered for inclusion in prostate cancer survivorship care guidelines.
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5
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Niazi S, Vargas E, Spaulding A, Gustetic E, Ford N, Paly D, Tatum K, Clark MM, Rummans T. Barriers to accepting mental health care in cancer patients with depression. SOCIAL WORK IN HEALTH CARE 2020; 59:351-364. [PMID: 32536332 DOI: 10.1080/00981389.2020.1769248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/07/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to determine barriers to accepting mental health care among depressed cancer patients. Cancer patients who screened positive for depression were referred for mental health treatment and sent a validated questionnaire designed to assess barriers to receiving mental health care. Responses were compared between patients who accepted their referral and those who did not. Among 75 patients who agreed to participate, 51 (68%) completed the questionnaire. Reported barriers to accessing mental healthcare were not significantly different between the two groups but patients residing within 50 miles of the clinic had increased odds of attending their appointment.
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Affiliation(s)
- Shehzad Niazi
- Department of Psychiatry & Psychology, Mayo Clinic , Jacksonville, FL, USA
- Robert D. And Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic , Jacksonville, Florida, USA
| | - Emily Vargas
- Robert D. And Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic , Jacksonville, Florida, USA
- Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida, USA
| | - Aaron Spaulding
- Robert D. And Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic , Jacksonville, Florida, USA
- Department of Health Sciences Research, Mayo Clinic , Jacksonville, Florida, USA
| | - Elaine Gustetic
- Section of Social Work, Mayo Clinic , Jacksonville, Florida, USA
| | - Nancy Ford
- Section of Social Work, Mayo Clinic , Jacksonville, Florida, USA
| | - David Paly
- Mayo Clinic School of Health Sciences, Mayo Clinic , Jacksonville, Florida, USA
| | - Kelsey Tatum
- Mayo Clinic School of Health Sciences, Mayo Clinic , Jacksonville, Florida, USA
| | - Matthew M Clark
- Department of Psychiatry & Psychology, Mayo Clinic , Rochester, Minnesota, USA
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic , Jacksonville, FL, USA
- Department of Psychiatry & Psychology, Mayo Clinic , Rochester, Minnesota, USA
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van der Vliet N, Suijkerbuijk AW, de Blaeij AT, de Wit GA, van Gils PF, Staatsen BA, Maas R, Polder JJ. Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062160. [PMID: 32213919 PMCID: PMC7142580 DOI: 10.3390/ijerph17062160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from other sectors, should be developed and implemented. Investing in these preventive health policies is challenging as budgets have to compete with other governmental expenditures. The current study aimed to identify, compare and rank cost-effective preventive interventions targeting metabolic, environmental, occupational and behavioral risk factors. To identify these interventions, a literature search was performed including original full economic evaluations of Western country interventions that had not yet been implemented in the Netherlands. Several workshops were held with experts from different disciplines. In total, 51 different interventions (including 13 cost saving interventions) were identified and ranked based on their incremental cost-effectiveness ratio (ICER) and potential averted disability-adjusted life years (DALYs), resulting in two rankings of the most cost-effective interventions and one ranking of the 13 cost saving interventions. This approach, resulting in an intersectoral ranking, can assist policy makers in implementing cost-effective preventive action that considers not only the health sector, but also other sectors.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
- Correspondence: ; Tel.: +3130-274-3816
| | - Anita W.M. Suijkerbuijk
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Adriana T. de Blaeij
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - G. Ardine de Wit
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Paul F. van Gils
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Brigit A.M. Staatsen
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Rob Maas
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Johan J. Polder
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
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Matcham F, Hotopf M, Roberts E, Galloway J, Scott IC, Steer S, Norton S. Reply. Arthritis Rheumatol 2019; 71:1025-1026. [DOI: 10.1002/art.40843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - James Galloway
- King's College London and King's College Hospital NHS Foundation Trust London UK
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Tuffaha H, El-Saifi N, Chambers S, Scuffham P. New challenges in psycho-oncology: Economic evaluation of psychosocial services in cancer: Challenges and best practice recommendations. Psychooncology 2018; 28:3-10. [PMID: 30440112 DOI: 10.1002/pon.4933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Haitham Tuffaha
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
| | - Najwan El-Saifi
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
| | - Suzanne Chambers
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul Scuffham
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia.,Griffith University Centre for Applied Health Economics, Nathan, Queensland, Australia
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9
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Weihs KL, Wiley JF, Crespi CM, Krull JL, Stanton AL. Predicting future major depression and persistent depressive symptoms: Development of a prognostic screener and PHQ-4 cutoffs in breast cancer patients. Psychooncology 2017; 27:420-426. [PMID: 28600855 DOI: 10.1002/pon.4472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/19/2017] [Accepted: 06/02/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Create a brief, self-report screener for recently diagnosed breast cancer patients to identify patients at risk of future depression. METHODS Breast cancer patients (N = 410) within 2 ± 1 months after diagnosis provided data on depression vulnerability. Depression outcomes were defined as a high depressive symptom trajectory or a major depressive episode during 16 months after diagnosis. Stochastic gradient boosting of regression trees identified 7 items highly predictive for the depression outcomes from a pool of 219 candidate depression vulnerability items. Three of the 7 items were from the Patient Health Questionnaire 4 (PHQ-4), a validated screener for current anxiety/depressive disorder that has not been tested to identify risk for future depression. Thresholds classifying patients as high or low risk on the new Depression Risk Questionnaire 7 (DRQ-7) and the PHQ-4 were obtained. Predictive performance of the DRQ-7 and PHQ-4 was assessed on a holdout validation subsample. FINDINGS DRQ-7 items assess loneliness, irritability, persistent sadness, and low acceptance of emotion as well as 3 items from the PHQ-4 (anhedonia, depressed mood, and worry). A DRQ-7 score of ≥6/23 identified depression outcomes with 0.73 specificity, 0.83 sensitivity, 0.68 positive predictive value, and 0.86 negative predictive value. A PHQ-4 score of ≥3/12 performed moderately well but less accurately than the DRQ-7 (net reclassification improvement = 10%; 95% CI [0.5-16]). INTERPRETATION The DRQ-7 and the PHQ-4 with a new cutoff score are clinically accessible screeners for risk of depression in newly diagnosed breast cancer patients. Use of the screener to select patients for preventive interventions awaits validation of the screener in other samples.
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Affiliation(s)
- Karen L Weihs
- Department of Psychiatry, University of Arizona, Tucson, Arizona, USA.,University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Joshua F Wiley
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia
| | - Catherine M Crespi
- Department of Psychology, University of California, Los Angeles, California, USA.,Department of Biostatistics, University of California, Los Angeles, California, USA
| | - Jennifer L Krull
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, California, USA.,Departments of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA
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Wanat M, Walker J, Burke K, Sevdalis N, Richardson A, Mulick A, Frost C, Sharpe M. Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study. BMJ Open 2017; 7:e016186. [PMID: 28674143 PMCID: PMC5734371 DOI: 10.1136/bmjopen-2017-016186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION There is growing awareness that cancer services need to address patients' well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients' symptoms including depression using a 'Symptom Monitoring Service' and (2) providing treatment for those with major depression using a programme called 'Depression Care for People with Cancer'. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients' and clinicians' experience of the programmes. METHODS AND ANALYSIS This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016-December 2018): 'Pre-implementation' (setting up of the new programmes), 'Early Implementation' (implementation of the programmes in a small number of clinics) and 'Implementation and Maintenance' (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. ETHICS AND DISSEMINATION The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford's Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences.
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Affiliation(s)
- Marta Wanat
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Jane Walker
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Katy Burke
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King’s College London, London, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Amy Mulick
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Chris Frost
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Sharpe
- Department of Psychiatry, Psychological Medicine Research, University of Oxford, Warneford Hospital, Oxford, UK
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Cortis LJ, Ward PR, McKinnon RA, Koczwara B. Integrated care in cancer: What is it, how is it used and where are the gaps? A textual narrative literature synthesis. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28426142 DOI: 10.1111/ecc.12689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 11/30/2022]
Abstract
Integrated care is an underpinning concept of contemporary health care policy proffered as a strategy to overcome the fragmentations in care encountered by people with complex care needs (Shaw et al. [2011] What is Integrated Care? An Overview of Integrated Care in the NHS). Cancer patients have potential to benefit from such policy, often having needs that extend beyond cancer. This paper seeks to understand how the concept of integrated care is used in the cancer literature. A search of leading databases was conducted for original research relating to integrated care or an integration intervention aiming to improve outcomes of cancer patients, and analysed using textual narrative synthesis. 38 papers were included, each with a focus on improving cancer-specific aspects of care enhancing the capabilities of the cancer multidisciplinary team. Of the eight studies involving integration between the cancer service and other care providers, all focused on utilising the external provider to deliver aspects of cancer care or placed them in a passive role, as survey participant, a recipient of cancer-related clinical information or as the comparator "usual care" arm. Within the cancer literature, integration is predominantly used to describe initiatives to improve cancer-related aspects of care. Less attention is given to integration initiatives that enhance coordination across levels of the healthcare system or service providers.
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Affiliation(s)
- L J Cortis
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - P R Ward
- Discipline of Public Health, School of Health Sciences, Flinders University, Adelaide, SA, Australia
| | - R A McKinnon
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
| | - B Koczwara
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia
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Janda M, Neale RE, Klein K, O'Connell DL, Gooden H, Goldstein D, Merrett ND, Wyld DK, Rowlands IJ, Beesley VL. Anxiety, depression and quality of life in people with pancreatic cancer and their carers. Pancreatology 2017; 17:321-327. [PMID: 28153446 DOI: 10.1016/j.pan.2017.01.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND People with pancreatic cancer have high levels of anxiety and depression and reduced quality of life (QoL), but few studies have assessed these outcomes for patient-carer dyads. We therefore investigated these issues in an Australian population-based study. METHODS Patients with pancreatic cancer (n = 136) and many of their carers (n = 84) completed the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Therapy QoL questionnaire at a median of three months after diagnosis. Overall QoL and well-being subscales (physical, social, emotional, functional) were compared with general population norms. Intraclass correlation coefficients were used to compare anxiety, depression and QoL scores of patients and their respective carers. RESULTS Fifteen percent of patients and 39% of carers had HADS scores indicative of anxiety and 15% of patients and 14% of carers of depression, respectively. Overall, 70% of patients and 58% of carers had QoL scores below the Queensland population average. Patients' anxiety, depression, overall QoL, social, emotional and functional wellbeing scores were significantly related to those scores in their carers. Among patients and carers, accessing psychological help was associated with elevated anxiety. Not receiving chemotherapy was associated with elevated depression among patients and younger age was associated with poorer outcomes in carers. CONCLUSIONS More carers had symptoms of anxiety than patients with pancreatic cancer, but symptoms of depression were similarly common in patients and carers. Further research is needed to assess whether interventions to reduce patients' distress could also improve QoL among carers, or whether carer-focussed interventions are required.
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Affiliation(s)
- Monika Janda
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kerenaftali Klein
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Helen Gooden
- Cancer Nursing Research Unit, University of Sydney, Sydney, Australia
| | - David Goldstein
- University of New South Wales, Sydney, Australia; Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Neil D Merrett
- South Western Sydney Upper GI Surgical Unit, Bankstown Hospital, Sydney, Australia; Discipline of Surgery, University of Western Sydney, Sydney, Australia
| | - David K Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Ingrid J Rowlands
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
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Walker J, Wanat M, Fielding J, Martin P, Petit A, Burke K, Sharpe M. Screening Medical Patients for Depression: Lessons From a National Program in Cancer Clinics. PSYCHOSOMATICS 2017; 58:274-280. [PMID: 28336194 DOI: 10.1016/j.psym.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening has been recommended to improve the identification of depression in medical patients. There is, therefore, a need for useful practical information on how to successfully implement large-scale depression screening in medical clinics. OBJECTIVE To describe the practical lessons learned from our experience of implementing a large-scale depression screening program in cancer clinics throughout Scotland, UK. METHOD Reflective review based on the experience of the screening team and records of the iterative development of the program. FINDINGS Systematic screening for depression in patients with medical illnesses can be delivered in clinics as long as the program is well designed. Design issues include ensuring the engagement of staff and patients, implementing efficient 2-stage screening processes and effectively managing workflow and quality assurance. DISCUSSION Screening has the potential to offer a solution to the well-documented problem of missed depression and other psychiatric diagnoses, thereby improving patient care if closely linked to treatment provision.
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Affiliation(s)
- Jane Walker
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Marta Wanat
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Josephine Fielding
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Paul Martin
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Ariane Petit
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Katy Burke
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
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Baeza-Velasco C, Baguet F, Allart P, Aguerre C, Sultan S, Ninot G, Soubeyran P, Cousson-Gelie F. Major depressive disorder and associated factors in elderly patients with non-Hodgkin’s lymphoma. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2016.1264879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Carolina Baeza-Velasco
- Institut de Psychologie, Université Paris Descartes, Sorbonne Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA, Paris, France
| | - Fanny Baguet
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Priscilla Allart
- Université de Bordeaux, Laboratoire Psychologie Santé et Qualité de Vie EA, Bordeaux, France
| | - Colette Aguerre
- Université François Rabelais, Laboratoire Psychologie des Ages de la Vie EA, Tours, France
| | - Serge Sultan
- Université de Montréal, CHU Sainte-Justine, QC, Canada
| | - Gregory Ninot
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
| | - Pierre Soubeyran
- Departement d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Florence Cousson-Gelie
- Institut Régional du Cancer de Montpellier, Epidaure Pôle Prévention, Montpellier, France
- Université Montpellier 1 & 3, Laboratory Epsylon EA, Dynamics of Human Abilities and Health Behaviors, Montpellier, France
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15
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Li M, Kennedy EB, Byrne N, Gérin-Lajoie C, Katz MR, Keshavarz H, Sellick S, Green E. Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psychooncology 2016; 26:573-587. [PMID: 27643388 DOI: 10.1002/pon.4286] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/17/2016] [Accepted: 09/15/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous systematic reviews have found limited evidence for the effectiveness of pharmacological and psychological interventions for the management of depression in patients with cancer. This paper provides the first meta-analysis of newer collaborative care interventions, which may include both types of treatment, as well as integrated delivery and follow-up. Meta-analyses of pharmacological and psychological interventions are included as a comparison. METHODS A search of MEDLINE, EMBASE, PsycINFO, and the Cochrane Library from July 2005 to January 2015 for randomized controlled trials of depression treatments for cancer patients diagnosed with a major depressive disorder, or who met a threshold on a validated depression rating scale was conducted. Meta-analyses were conducted using summary data. RESULTS Key findings included eight reports of four collaborative care interventions, eight pharmacological, and nine psychological trials. A meta-analysis demonstrated that collaborative care interventions were significantly more effective than usual care (standardized mean difference = -0.49, p = 0.003), and depression reduction was maintained at 12 months. By comparison, short-term (up to 12 weeks), but not longer-term effectiveness was demonstrated for both pharmacological and psychological interventions. CONCLUSIONS Collaborative care interventions have newly emerged as multidisciplinary care delivery models, which may result in more long-term depression remission. This review also updates previous findings of modest evidence for the effectiveness of both pharmacological and psychological interventions for threshold depression in cancer patients. Research designs focusing on combined treatments and delivery systems may best further the limited evidence-base for the management of depression in cancer.
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Affiliation(s)
- Madeline Li
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Erin B Kennedy
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Nelson Byrne
- Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga, Ontario, Canada
| | | | - Mark R Katz
- Stronach Regional Cancer Centre, Southlake Regional Health Centre, Ontario, Canada
| | - Homa Keshavarz
- Cancer Care Ontario, Program in Evidence-based Care/McMaster University, Hamilton, Ontario, Canada
| | - Scott Sellick
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada
| | - Esther Green
- Nursing and Psychosocial Oncology, Cancer Care Ontario, Toronto, Ontario, Canada
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16
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Camacho EM, Ntais D, Coventry P, Bower P, Lovell K, Chew-Graham C, Baguley C, Gask L, Dickens C, Davies LM. Long-term cost-effectiveness of collaborative care (vs usual care) for people with depression and comorbid diabetes or cardiovascular disease: a Markov model informed by the COINCIDE randomised controlled trial. BMJ Open 2016; 6:e012514. [PMID: 27855101 PMCID: PMC5073527 DOI: 10.1136/bmjopen-2016-012514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To evaluate the long-term cost-effectiveness of collaborative care (vs usual care) for treating depression in patients with diabetes and/or coronary heart disease (CHD). SETTING 36 primary care general practices in North West England. PARTICIPANTS 387 participants completed baseline assessment (collaborative care: 191; usual care: 196) and full or partial 4-month follow-up data were captured for 350 (collaborative care: 170; usual care: 180). 62% of participants were male, 14% were non-white. Participants were aged ≥18 years, listed on a Quality and Outcomes Framework register for CHD and/or type 1 or 2 diabetes mellitus, with persistent depressive symptoms. Patients with psychosis or type I/II bipolar disorder, actively suicidal, in receipt of services for substance misuse, or already in receipt of psychological therapy for depression were excluded. INTERVENTION Collaborative care consisted of evidence-based low-intensity psychological treatments, delivered over 3 months and case management by a practice nurse and a Psychological Well Being Practitioner. OUTCOME MEASURES As planned, the primary measure of cost-effectiveness was the incremental cost-effectiveness ratio (cost per quality-adjusted life year (QALY)). A Markov model was constructed to extrapolate the trial results from short-term to long-term (24 months). RESULTS The mean cost per participant of collaborative care was £317 (95% CI 284 to 350). Over 24 months, it was estimated that collaborative care was associated with greater healthcare usage costs (net cost £674 (95% CI -30 953 to 38 853)) and QALYs (net QALY gain 0.04 (95% CI -0.46 to 0.54)) than usual care, resulting in a cost per QALY gained of £16 123, and a likelihood of being cost-effective of 0.54 (willingness to pay threshold of £20 000). CONCLUSIONS Collaborative care is a potentially cost-effective long-term treatment for depression in patients with comorbid physical and mental illness. The estimated cost per QALY gained was below the threshold recommended by English decision-makers. Further, long-term primary research is needed to address uncertainty associated with estimates of cost-effectiveness. TRIAL REGISTRATION NUMBER ISRCTN80309252; Post-results.
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Affiliation(s)
- Elizabeth M Camacho
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Peter Coventry
- Mental Health and Addiction Research Group, University of York, York, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Karina Lovell
- The School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Carolyn Chew-Graham
- Centre for Primary Care, University of Manchester, Manchester, UK
- Primary Care & Health Sciences, University of Keele, Staffordshire, UK
| | | | - Linda Gask
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Chris Dickens
- Mental Health Research Group, University of Exeter, Exeter, UK
| | - Linda M Davies
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
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17
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Duarte A, Walker J, Walker S, Richardson G, Holm Hansen C, Martin P, Murray G, Sculpher M, Sharpe M. Cost-effectiveness of integrated collaborative care for comorbid major depression in patients with cancer. J Psychosom Res 2015; 79:465-70. [PMID: 26652589 PMCID: PMC4678258 DOI: 10.1016/j.jpsychores.2015.10.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/26/2015] [Accepted: 10/30/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Comorbid major depression is associated with reduced quality of life and greater use of healthcare resources. A recent randomised trial (SMaRT, Symptom Management Research Trials, Oncology-2) found that a collaborative care treatment programme (Depression Care for People with Cancer, DCPC) was highly effective in treating depression in patients with cancer. This study aims to estimate the cost-effectiveness of DCPC compared with usual care from a health service perspective. METHODS Costs were estimated using UK national unit cost estimates and health outcomes measured using quality-adjusted life-years (QALYs). Incremental cost-effectiveness of DCPC compared with usual care was calculated and scenario analyses performed to test alternative assumptions on costs and missing data. Uncertainty was characterised using cost-effectiveness acceptability curves. The probability of DCPC being cost-effective was determined using the UK National Institute for Health and Care Excellence's (NICE) cost-effectiveness threshold range of £ 20,000 to £ 30,000 per QALY gained. RESULTS DCPC cost on average £ 631 more than usual care per patient, and resulted in a mean gain of 0.066 QALYs, yielding an incremental cost-effectiveness ratio of £ 9549 per QALY. The probability of DCPC being cost-effective was 0.9 or greater at cost-effectiveness thresholds above £ 20,000 per QALY for the base case and scenario analyses. CONCLUSIONS Compared with usual care, DCPC is likely to be cost-effective at the current thresholds used by NICE. This study adds to the weight of evidence that collaborative care treatment models are cost-effective for depression, and provides new evidence regarding their use in specialist medical settings.
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Affiliation(s)
- A Duarte
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - J Walker
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
| | - S Walker
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - G Richardson
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - C Holm Hansen
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
| | - P Martin
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK.
| | - G Murray
- University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK.
| | - M Sculpher
- Centre for Health Economics, University of York, Heslington, York, UK.
| | - M Sharpe
- Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.
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18
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Chatterton ML, Chambers S, Occhipinti S, Girgis A, Dunn J, Carter R, Shih S, Mihalopoulos C. Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality-adjusted life years. Psychooncology 2015; 25:857-64. [DOI: 10.1002/pon.4020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/04/2015] [Accepted: 10/12/2015] [Indexed: 11/09/2022]
Affiliation(s)
| | - Suzanne Chambers
- Griffith Health Institute; Griffith University; Brisbane Australia
- Cancer Council Queensland; Brisbane Australia
- Prostate Cancer Foundation of Australia; Sydney Australia
| | | | - Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School; University of New South Wales; Sydney Australia
| | - Jeffrey Dunn
- Griffith Health Institute; Griffith University; Brisbane Australia
- Cancer Council Queensland; Brisbane Australia
- School of Medicine; Griffith University; Brisbane Australia
- School of Social Science; The University of Queensland; Brisbane Australia
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19
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Rubin G, Berendsen A, Crawford SM, Dommett R, Earle C, Emery J, Fahey T, Grassi L, Grunfeld E, Gupta S, Hamilton W, Hiom S, Hunter D, Lyratzopoulos G, Macleod U, Mason R, Mitchell G, Neal RD, Peake M, Roland M, Seifert B, Sisler J, Sussman J, Taplin S, Vedsted P, Voruganti T, Walter F, Wardle J, Watson E, Weller D, Wender R, Whelan J, Whitlock J, Wilkinson C, de Wit N, Zimmermann C. The expanding role of primary care in cancer control. Lancet Oncol 2015; 16:1231-72. [PMID: 26431866 DOI: 10.1016/s1470-2045(15)00205-3] [Citation(s) in RCA: 355] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 12/21/2022]
Abstract
The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to effect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development.
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Affiliation(s)
- Greg Rubin
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK.
| | - Annette Berendsen
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | | | - Rachel Dommett
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Craig Earle
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Jon Emery
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Tom Fahey
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Eva Grunfeld
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Sumit Gupta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - David Hunter
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Una Macleod
- Hull-York Medical School, University of Hull, Hull, UK
| | - Robert Mason
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Geoffrey Mitchell
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Richard D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | | | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Bohumil Seifert
- Department of General Practice, Charles University, Prague, Czech Republic
| | - Jeff Sisler
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | | | - Stephen Taplin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Peter Vedsted
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Teja Voruganti
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Fiona Walter
- Department of General Practice, University of Groningen, Groningen, Netherlands
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Eila Watson
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Jeremy Whelan
- Research Department of Oncology, University College London, London, UK
| | - James Whitlock
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, Wales
| | - Niek de Wit
- Department of General Practice, University Medical Center Utrecht, Utrecht, Netherlands
| | - Camilla Zimmermann
- Division of Medical Oncology and Haematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems. Support Care Cancer 2015; 24:763-771. [PMID: 26143040 DOI: 10.1007/s00520-015-2840-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Poor health of one spouse can adversely influence the partner's health outcomes ("spillover"). This study aimed to estimate quality of life spillover among spouses and to determine how presence of cancer influenced these effects. METHODS We examined data on husband-wife dyads with cancer-related health problems, medical events, or disabilities (n = 910) and matched comparison dyads from the 2004-2012 Medical Expenditures Panel Survey, a population-based survey of the USA. Mental and physical health-related quality of life and depressed mood were reported at two time points (T1 and T2, 11 months apart on average). Dyadic multilevel models evaluated the cross-lagged impact of HRQoL and depressed mood at T1 on spouses' HRQoL at T2, controlling for sociodemographics and health conditions. RESULTS Small but statistically significant spillover was observed for mental and physical HRQoL among couples with cancer. Spillover occurred from both the spouse to the survivor and from survivor to spouse. Depressed mood, in particular, showed stronger spillover effects from the spouse to the survivor than the inverse. Similar effects were not observed in dyads without cancer. CONCLUSIONS Screening for and treating poor HRQoL and depressed mood concurrently in both cancer survivors, and their spouses may positively influence HRQoL outcomes. Future research is needed to further elucidate these findings and determine whether a concurrent approach to psychosocial care in survivors and their spouses may improve long-term outcomes.
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Schofield P, Chambers S. Effective, clinically feasible and sustainable: Key design features of psycho-educational and supportive care interventions to promote individualised self-management in cancer care. Acta Oncol 2015; 54:805-12. [PMID: 25813474 DOI: 10.3109/0284186x.2015.1010016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED As the global burden of cancer increases healthcare services will face increasing challenges in meet the complex needs of these patients, their families and the communities in which they live. This raises the question of how to meet patient need where direct clinical contact may be constrained or not readily available. Patients and families require resources and skills to manage their illness outside of the hospital setting within their own communities. AIM To propose a framework for the development and delivery of psycho-educational and supportive care interventions drawing on theoretical principles of behaviour change and evidence-based interventions, and based on extensive experience in developing and testing complex interventions in oncology. APPROACH At the core of this intervention framework are considerations of efficiency: interventions are designed to cater for individuals' unique needs; to place minimal demands on the health system infrastructure and to be rapidly disseminated into usual care if successful. There are seven key features: 1) Targeting cancer type and stage; 2) Tailoring to unique individual needs; 3) Promotion of patient self-management of their disease and treatment side effects; 4) Efficient delivery of the intervention; 5) Training and adherence to protocol; 6) Ensuring the intervention is evidence-based; 7) Confirming stakeholder acceptability of the intervention. APPLICATION A case study of a randomised controlled trial which tested psycho-educational oncology interventions using this framework is presented. These interventions were designed to cater for individuals' unique needs and promote self-management while placing minimal demands on the acute health care setting. DISCUSSION Innovative ways to realise the potentially major impact that psycho-educational and supportive care interventions can have on psychological morbidity, coping, symptoms and quality of life in serious and chronic illness are needed. This framework, which is driven by theory, evidence, and experience, is designed to ensure that interventions are effective, clinically feasible and sustainable.
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Affiliation(s)
- Penelope Schofield
- Department of Psychology, Swinburne University of Technology , Melbourne, Victoria , Australia
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22
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Chambers SK, Grassi L, Hyde MK, Holland J, Dunn J. Integrating psychosocial care into neuro-oncology: challenges and strategies. Front Oncol 2015; 5:41. [PMID: 25756038 PMCID: PMC4337368 DOI: 10.3389/fonc.2015.00041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/04/2015] [Indexed: 11/13/2022] Open
Abstract
Approximately 256,000 cases of malignant brain and nervous system cancer were diagnosed worldwide during 2012 and 189,000 deaths, with this burden falling more heavily in the developed world. Problematically, research describing the psychosocial needs of people with brain tumors and their carers and the development and evaluation of intervention models has lagged behind that of more common cancers. This may relate, at least in part, to poor survival outcomes and high morbidity associated with this illness, and stigma about this disease. The evidence base for the benefits of psychosocial care in oncology has supported the production of clinical practice guidelines across the globe over the past decade, with a recent mandate to integrate the psychosocial domain and measurement of distress into routine care. Clinical care guidelines for people with brain tumors have emerged, with a building focus on psychosocial and survivorship care. However, researchers will need to work intensively with health care providers to ensure future practice is evidence-based and able to be implemented across both acute and community settings and likely within existing resources.
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Affiliation(s)
- Suzanne K. Chambers
- Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
- Cancer Council Queensland, Brisbane, QLD, Australia
- Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia
- Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
- Centre for Clinical Research, University of Queensland, Brisbane, QLD, Australia
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Melissa K. Hyde
- Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
- Cancer Council Queensland, Brisbane, QLD, Australia
| | - Jimmie Holland
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeff Dunn
- Griffith Health Institute, Griffith University, Brisbane, QLD, Australia
- Cancer Council Queensland, Brisbane, QLD, Australia
- School of Medicine, Griffith University, Brisbane, QLD, Australia
- School of Social Science, University of Queensland, Brisbane, QLD, Australia
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23
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Chambers SK, Occhipinti S, Schover L, Nielsen L, Zajdlewicz L, Clutton S, Halford K, Gardiner RA, Dunn J. A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners. Psychooncology 2014; 24:748-56. [DOI: 10.1002/pon.3726] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Suzanne K. Chambers
- School of Applied Psychology; Griffith University; Brisbane Australia
- Cancer Council Queensland; Brisbane Australia
- Prostate Cancer Foundation of Australia; Sydney Australia
- University of Queensland Centre for Clinical Research; University of Queensland; Brisbane Australia
- Health and Wellness Institute; Edith Cowan University; Perth Australia
| | | | - Leslie Schover
- Department of Behavioral Science; University of Texas MD Anderson Cancer Center; Houston USA
| | | | | | | | - Kim Halford
- School of Psychology; University of Queensland; Brisbane Australia
| | - Robert A. Gardiner
- University of Queensland Centre for Clinical Research; University of Queensland; Brisbane Australia
- Department of Urology; Royal Brisbane and Women's Hospital; Brisbane Australia
| | - Jeff Dunn
- Cancer Council Queensland; Brisbane Australia
- School of Medicine; Griffith University; Brisbane Australia
- School of Social Science; University of Queensland; Brisbane Australia
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