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Lombi L, Alfieri S, Brunelli C. 'Why should I fill out this questionnaire?' A qualitative study of cancer patients' perspectives on the integration of e-PROMs in routine clinical care. Eur J Oncol Nurs 2023; 63:102283. [PMID: 36893578 DOI: 10.1016/j.ejon.2023.102283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE There is increasing interest in integrating electronic patient-reported outcomes (e-PROs) into clinical routines in cancer settings. However, little is known about patients' experiences with and perceptions of e-PRO measures (e-PROMs). This study examines patients' experiences with e-PROMS, particularly their perspectives about its usefulness and its implications for the clinical encounter with their doctors. METHOD A total of 19 individual in-person interviews with cancer patients at a Comprehensive Cancer Center in northern Italy conducted in 2021 inform this study. RESULTS The findings suggested that, overall, patients had positive attitudes towards data collection using e-PROMs. On the one hand, most patients found the integration of e-PROMs into routine clinical practice as beneficial in treating patients with cancer. The main benefits of e-PROMs according to this group of patients were that: they promoted patient-centred care; could be used to tailor and improve the quality of care through a holistic approach; supported early detection of problematic symptoms; increased patient self-awareness; and contributed to clinical research. On the other hand, many patients did not fully understand the purpose of e-PROMs and some patients were also sceptical about their usefulness in routine clinical practice. CONCLUSIONS These findings have several practical implications for ensuring the successful implementation of e-PROMs in routine clinical practice. These include the following preconditions: patients are informed about the purposes of data collection; physicians provide feedback to patients about the e-PROMs' results; and that hospital administrators allocate sufficient time for clinical interactions to integrate e-PROMs into routine clinical practice.
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Affiliation(s)
- Linda Lombi
- Department of Sociology, Università Cattolica del Sacro Cuore, Italy.
| | - Sara Alfieri
- Clinical psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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2
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Evaluation of an electronic psycho-oncological adaptive screening program (EPAS) with immediate patient feedback: findings from a German cluster intervention study. J Cancer Surviv 2021; 16:1401-1413. [PMID: 34735695 DOI: 10.1007/s11764-021-01121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Distress screening has become mandatory and essential in comprehensive cancer care. We evaluated an electronic psycho-oncological adaptive screening (EPAS) which assesses objective indicators of care needs and subjectively perceived care needs and subsequently provides patient feedback with individualized recommendations about psychosocial care services. METHODS Patients were assessed within clusters, i.e., different oncological facilities of the competence network of the University Cancer Center Hamburg (UCCH). Patients in the intervention arm underwent the screening, controls received standard care. Patients were assessed at baseline (t0), 3-month (t1), and 6-month (t2) follow-up. Outcomes included information level and use of/access to nine psychosocial services at UCCH, well-being (GAD-7, PHQ-9, SF-8), and treatment satisfaction (SCCC). Conditional linear and logistic regressions were used to identify screening effects at t1 and t2. RESULTS Of 1320 eligible patients across 11 clusters, 660 were included (50%). The average age was 60 years; 46% were female. The intervention was associated with increased information level for all psychosocial services at t1 and t2 (all p < .001), increased use in some of these services at t1 and t2, respectively (p ≤ .02), and better evaluation of access (e.g., more recommendations for services provided by physicians, p < .01). At t2, the intervention was associated with a lower level of satisfaction with disease-related information (p = .02). CONCLUSIONS EPAS may improve information about psychosocial services as well as utilization of and access to these services. The effect on information level seems not to be generalizable to other aspects of oncological care. Future studies should incorporate novel technologies and condense the procedure to its core factors. IMPLICATIONS FOR CANCER SURVIVORS The screening may help to enhance self-management competencies among cancer survivors. TRIAL REGISTRATION The trial was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).
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3
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Şirin T, Göksel F. Investigation of the Spiritual Care Effects on Anxiety, Depression, Psychological Distress and Spiritual Levels of Turkish Muslim Radiotherapy Patients. JOURNAL OF RELIGION AND HEALTH 2021; 60:2484-2502. [PMID: 33128709 DOI: 10.1007/s10943-020-01117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study is to examine the spiritual care support given to Muslim cancer patients undergoing radiotherapy with an experimental study on the spirituality, anxiety, depression and distress levels of these patients. In this study, experimental research design with experimental control group was used. Personal information form designed by researchers, HAD scale, DT scale and Spirituality Scale was used for personal information. In conclusion, it was determined that the support for Islamic spiritual care had positive effects on hospitalized radiotherapy patients. According to the results obtained, it is recommended to examine in larger sample groups in different treatment programs in order to reveal the effect of spiritual care support.
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Affiliation(s)
- Turgay Şirin
- Islamic Sciences Faculty, Department of Psychology of Religion, Istanbul Sabahattin Zaim University, Halkalı Street, No: 281 Halkalı, Küçükcekmece, Istanbul, 34303, Turkey.
| | - Fatih Göksel
- Department of Radiation Oncology, SBÜ Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Mehmet Akif Ersoy Street, Yenimahalle, 06200, Ankara, Turkey
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4
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Bonomo P, Paderno A, Mattavelli D, Zenda S, Cavalieri S, Bossi P. Quality Assessment in Supportive Care in Head and Neck Cancer. Front Oncol 2019; 9:926. [PMID: 31620372 PMCID: PMC6759470 DOI: 10.3389/fonc.2019.00926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023] Open
Abstract
Quality assessment is a key issue in every clinical intervention, to be periodically performed so to measure the adherence to standard and to possibly implement strategies to improve its performance. This topic is rarely discussed for what concerns supportive care; however, it is necessary to verify the quality of the supportive measures; “supportive care makes excellent cancer care possible,” as stated by the Multinational Association of Supportive Care in Cancer (MASCC). In this regard, the quality of supportive care in head and neck cancer patients is a crucial topic, both to allow administration of treatments according to planned dose intensity or surgical indications and to maintain or improve patients' quality of life. This paper aims to provide insight on state of the art supportive care and its future developments for locally advanced and recurrent/metastatic head and neck cancer, with a focus on quality assessment in relation to surgery, radiotherapy, and systemic therapy.
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Affiliation(s)
- Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical Oncology, ASST Spedali Civili di Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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5
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Pichler T, Dinkel A, Marten-Mittag B, Hermelink K, Telzerow E, Ackermann U, Belka C, Combs SE, Gratzke C, Gschwend J, Harbeck N, Heinemann V, Herkommer K, Kiechle M, Mahner S, Pigorsch S, Rauch J, Stief C, Beckmann J, Heußner P, Herschbach P. Factors associated with the decline of psychological support in hospitalized patients with cancer. Psychooncology 2019; 28:2049-2059. [PMID: 31368613 DOI: 10.1002/pon.5191] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/20/2019] [Accepted: 07/21/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Many distressed cancer patients do not want or, finally, do not use psychological support. This study aimed at identifying factors associated with the decline of psychological support during hospital stay. METHODS This cross-sectional study included inpatients with different cancer diagnoses. Distress was assessed using the short form of the Questionnaire on Stress in Cancer Patients-Revised (QSC-R10) and the Distress Thermometer (DT). Multivariable logistic regression was used to identify factors associated with decline. RESULTS Of 925 patients, 71.6% (n = 662) declined psychological support. Male sex (OR = 2.54, 95% CI = 1.69-3.80), low psychosocial distress (OR = 3.76, CI = 2.50-5.67), not feeling depressed (OR = 1.93, CI = 1.24-2.99), perceived overload (OR = 3.37, CI = 2.19-5.20), no previous psychological treatment (OR = 1.88, CI = 1.25-2.83), and feeling well informed about psychological support (OR = 1.66, CI = 1.11-2.46) were associated with decline. Among the patients who indicated clinical distress (46.2%), 53.9% declined psychological support. Male sex (OR = 2.96, CI = 1.71-5.12), not feeling depressed (OR = 1.87, CI = 1.12-3.14), perceived overload (OR = 5.37, CI = 3.07-9.37), agreeableness (OR = 0.70, CI = 0.51-0.95), and feeling well informed about psychological support (OR = 1.81, CI = 1.07-3.07) were uniquely associated with decline in this subgroup. CONCLUSIONS Decline of psychological support is primarily due to psychological factors. Feeling well informed about support emerged as a relevant factor associated with decline. Thus, design of informational material and education about available psychological services seem crucial.
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Affiliation(s)
- Theresia Pichler
- Comprehensive Cancer Center, Munich, Germany.,Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- School of Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Birgitt Marten-Mittag
- School of Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | - Kerstin Hermelink
- Department of Gynaecology and Obstetrics, University Hospital of Munich, Munich, Germany
| | - Eva Telzerow
- Comprehensive Cancer Center, Munich, Germany.,Department of Internal Medicine III, University Hospital of Munich, Munich, Germany
| | - Ulrike Ackermann
- School of Medicine, Klinikum rechts der Isar, Department of Gynaecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of Munich, Munich, Germany
| | - Stephanie E Combs
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Christian Gratzke
- Department of Urology, University Hospital of Freiburg, Freiburg, Germany.,Department of Urology, University Hospital of Munich, Munich, Germany
| | - Jürgen Gschwend
- School of Medicine, Klinikum rechts der Isar, Department of Urology, Technical University of Munich, Munich, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynaecology and Obstetrics, University Hospital of Munich, Munich, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center, Munich, Germany.,Department of Internal Medicine III, University Hospital of Munich, Munich, Germany
| | - Kathleen Herkommer
- School of Medicine, Klinikum rechts der Isar, Department of Urology, Technical University of Munich, Munich, Germany
| | - Marion Kiechle
- School of Medicine, Klinikum rechts der Isar, Department of Gynaecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Sven Mahner
- Department of Gynaecology and Obstetrics, University Hospital of Munich, Munich, Germany
| | - Steffi Pigorsch
- School of Medicine, Klinikum rechts der Isar, Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Josefine Rauch
- Department of Radiation Oncology, University Hospital of Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital of Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Pia Heußner
- Department of Internal Medicine III, University Hospital of Munich, Munich, Germany.,Cancer Center Oberland, Garmisch-Partenkirchen General Hospital, Garmisch-Partenkirchen, Germany
| | - Peter Herschbach
- Comprehensive Cancer Center, Munich, Germany.,School of Medicine, Klinikum rechts der Isar, Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
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6
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Cancer patients' wish for psychological support during outpatient radiation therapy : Findings from a psychooncological monitoring program in clinical routine. Strahlenther Onkol 2018. [PMID: 29532098 PMCID: PMC6008369 DOI: 10.1007/s00066-018-1288-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer patients frequently suffer from physical and psychosocial impairments due to their disease and its treatment. Psychooncology (PO) can help to cope with stress resulting from outpatient radiotherapy (RT) treatment. There are currently few data regarding patients' wishes for PO support. The aim of this study was to investigate the number of patients with a wish for PO, treatment paths, and predictors of the wish for PO among cancer patients at the beginning of RT. METHODS The results of routine psychological stress screening (Hornheide screening instrument; cut-off ≥ 4) of 944 cancer patients between 2015 and 2017 were analyzed in a retrospective cross-sectional study. Predictors for a wish for PO support were identified by stepwise binary logistic regression, in which sociodemographic and treatment data were included in addition to the screening items. RESULTS Around 20% of patients had above-average stress levels and 13% expressed a wish for PO support (participation rate was approximately 55%). Low emotional wellbeing (OR = 11.3) and lack of social support (OR = 9.4) were strong predictors for this treatment wish. Among patients with pancreatic cancer, head and neck tumors, and hematologic disease, there was a substantial difference between the degree of psychological stress and the wish for treatment. Patients with urological (23.5%) and lung tumors (20.9%) most frequently expressed a wish for PO support. CONCLUSION Patient-reported psychosocial problems were better predictors of a wish for PO support than sociodemographic or clinical data. Stress screening should thus be implemented in clinical routine.
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7
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Tonsing KN, Vungkhanching M. Assessing psychological distress in cancer patients: The use of distress thermometer in an outpatient cancer/hematology treatment center. SOCIAL WORK IN HEALTH CARE 2018; 57:126-136. [PMID: 29135393 DOI: 10.1080/00981389.2017.1402844] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study is to assess the feasibility of the distress thermometer (DT) and the accompanying problem checklist (PC) as a screening tool for psychological distress and the sources of those distress at an outpatient cancer treatment center in Central California. Forty-three patients completed the DT and the PC. Based on a recommended DT cutoff score of 4, patients were classified as "distressed" (>4) and "not-distressed" (<4). Respondents ranged in age from 34 to 87 years (mean = 60.44, SD = 12.05), the majority of whom were female (55.8%). The most common types of cancer diagnosis were breast cancer, followed by blood abnormality (i.e., blood disorders), lung, and bladder cancer. Based on the recommended DT cutoff score, 51% of patients were identified as significantly distressed. Results showed significant difference on DT score between the distressed and not-distressed groups, t(41) = -4.25, p < .001. The most commonly reported sources of distress were in the practical, emotional, and physical domains of the PC list. Routine distress screening can significantly help improve identification of distress and the sources of the distress in cancer patients and enable healthcare professionals to facilitate appropriate psychosocial support and referrals. Implications for practice and research are discussed.
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Affiliation(s)
- Kareen N Tonsing
- a Sociology, Anthropology, Social Work & Criminal Justice , Oakland University , Rochester , MI , USA
| | - Martha Vungkhanching
- b Department of Social Work Education, College of Health and Human Services , California State University , Fresno , CA , USA
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8
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van Overveld L, Takes R, Turan A, Braspenning J, Smeele L, Merkx M, Hermens R. Needs and preferences of patients with head and neck cancer in integrated care. Clin Otolaryngol 2017; 43:553-561. [DOI: 10.1111/coa.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/28/2022]
Affiliation(s)
- L.F.J. van Overveld
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - R.P. Takes
- Department of Otolaryngology, Head and Neck surgery; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - A.S. Turan
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
- Radboud University Medical Centre; Nijmegen the Netherlands
| | - J.C.C. Braspenning
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - L.E. Smeele
- Department of Head and Neck Surgery and Oncology; Antoni van Leeuwenhoek Nederlands Kanker Instituut; Amsterdam the Netherlands
- Department of Oral and Maxillofacial Surgery; Academisch Medisch Centrum; Amsterdam Zuid-Oost the Netherlands
| | - M.A.W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
| | - R.P.M.G. Hermens
- Scientific Center for Quality of Healthcare; Radboud Institute for Health Sciences; Radboud University Medical Centre; Nijmegen the Netherlands
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9
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Patient-reported outcome use in oncology: a systematic review of the impact on patient-clinician communication. Support Care Cancer 2017; 26:41-60. [PMID: 28849277 DOI: 10.1007/s00520-017-3865-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient-reported outcomes (PROs) are an increasingly popular tool to optimize care and bridge the gap between patient experience and clinician understanding. The aim of this review was to identify mechanisms through which PROs facilitate patient-clinician communication in the adult oncology population. METHODS We conducted a systematic review of the published literature using the following data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, Cab Direct, and CDSR. Studies included in this review reported on the outcomes of PRO use, used PROs as an intervention and not as a study outcome measurement tool, included cancer patients or survivors as study participants, and analyzed patient-clinician communication. RESULTS We identified 610 unique records, of which 43 publications met the inclusion and exclusion criteria. Synthesis of the reviewed studies provided evidence of the usefulness of PROs in facilitating patient-clinician communication on a variety of topics. We identified mechanisms though which PROs influenced patient-clinician communication to include increasing symptom awareness, prompting discussion, streamlining consultations, and facilitating inter-professional communication. Barriers to PRO use in communication improvement include technical problems impeding its administration and completion, compliance issues due to lack of incentive or forgetfulness, and use of PROs that do not appropriately assess issues relevant to the patient. Facilitators include increased education on PRO use, using PRO tools that patients find more acceptable, and providing patient data summaries in an easily accessible format for clinicians. CONCLUSIONS Our review suggests that PROs facilitate patient-clinician communication through various mechanisms that could perhaps contribute to improvements in symptom management and survival. The impact of PROs on clinical outcomes, however, remains poorly studied.
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Körner P, Ehrmann K, Hartmannsgruber J, Metz M, Steigerwald S, Flentje M, van Oorschot B. Patient-reported symptoms during radiotherapy : Clinically relevant symptom burden in patients treated with palliative and curative intent. Strahlenther Onkol 2017; 193:570-577. [PMID: 28573475 DOI: 10.1007/s00066-017-1146-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 04/27/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. PATIENTS AND METHODS Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). RESULTS Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. CONCLUSION Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom burden. The results prove the need of systematic symptom assessment and programs for early integrated supportive and palliative care in radiation oncology.
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Affiliation(s)
- Philipp Körner
- Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany. .,Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg, Germany.
| | - Katja Ehrmann
- Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Michaela Metz
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Sabrina Steigerwald
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Birgitt van Oorschot
- Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
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11
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Habboush Y, Shannon RP, Niazi SK, Hollant L, Single M, Gaines K, Smart B, Chimato NT, Heckman MG, Buskirk SJ, Vallow LA, Tzou KS, Ko SJ, Peterson JL, Biers HA, Day AB, Nelson KA, Sloan JA, Halyard MY, Miller RC. Patient-reported distress and survival among patients receiving definitive radiation therapy. Adv Radiat Oncol 2017; 2:211-219. [PMID: 28740934 PMCID: PMC5514245 DOI: 10.1016/j.adro.2017.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Patient-reported distress (PRD) has not been well assessed in association with survival after radiation therapy (RT). The aims of this study were to evaluate the association between PRD level and survival after definitive RT and to identify the main causes of distress in definitive RT patients. METHODS AND MATERIALS A total of 678 consecutive patients receiving definitive RT at our institution from April 2012 through May 2015 were included. All patients answered a PRD questionnaire that contained 30 items related to possible causes of distress, which could be rated from 1 (no distress) to 5 (high distress). Additionally, patients were asked to rate their overall distress level from 0 (no distress) to 10 (extreme distress). This overall distress level was our primary patient-reported distress measure and was examined as a continuous variable and as a categorical variable with 3 PRD levels (low, 0-3 [n = 295]; moderate, 4-6 [n = 222]; and high, 7-10 [n = 161]). RESULTS As a continuous variable in multivariable Cox regression analysis, a higher overall PRD level was associated with poorer survival after RT (hazard ratio [HR], 1.39; P = .004). As a categorical variable, compared with patients with low distress, survival was poorer for patients with moderate distress (HR, 1.62; P = .038) or high distress (HR, 1.49; P = .12), but the latter difference was not significant. When the moderate and high distress levels were combined, survival was significantly poorer compared with the low distress level (HR, 1.57; P = .034). The top 5 specific causes of distress that patients mentioned were "How I feel during treatment," "Fatigue," "Out-of-pocket medical costs," "Pain that affects my daily functioning," and "Sleep difficulties." CONCLUSIONS PRD before or during RT is a prognostic factor associated with decreased survival. Distress screening guidelines and interventions should be implemented for patients receiving definitive RT.
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Affiliation(s)
- Yacob Habboush
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Laeticia Hollant
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Megan Single
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Katherine Gaines
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Bridget Smart
- Visiting students, Mayo School of Health Sciences, Mayo Clinic College of Medicine, Jacksonville, Florida
| | | | | | - Steven J. Buskirk
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Laura A. Vallow
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Katherine S. Tzou
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | | | - Heather A. Biers
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Atiya B. Day
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Kimberly A. Nelson
- Division of Hematology/Oncology/Cancer Center/Breast Clinic, Mayo Clinic, Jacksonville, Florida
| | - Jeff A. Sloan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Michele Y. Halyard
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, Arizona
| | - Robert C. Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
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Campbell N, Ali F, Finlay AY, Salek SS. Equivalence of electronic and paper-based patient-reported outcome measures. Qual Life Res 2015; 24:1949-61. [PMID: 25702266 DOI: 10.1007/s11136-015-0937-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Abstract
AIM Electronic formats (ePROs) of paper-based patient-reported outcomes (PROs) should be validated before they can be reliably used. This review aimed to examine studies investigating measurement equivalence between ePROs and their paper originals to identify methodologies used and to determine the extent of such validation. METHODS Three databases (OvidSP, Web of Science and PubMed) were searched using a set of keywords. Results were examined for compliance with inclusion criteria. Articles or abstracts that directly compared screen-based electronic versions of PROs with their validated paper-based originals, with regard to their measurement equivalence, were included. Publications were excluded if the only instruments reported were stand-alone visual analogue scales or interactive voice response formats. Papers published before 2007 were excluded, as a previous meta-analysis examined papers published before this time. RESULTS Fifty-five studies investigating 79 instruments met the inclusion criteria. 53 % of the 79 instruments studied were condition specific. Several instruments, such as the SF-36, were reported in more than one publication. The most frequently reported formats for ePROs were Web-based versions. In 78 % of the publications, there was evidence of equivalence or comparability between the two formats as judged by study authors. Of the 30 publications that provided preference data, 87 % found that overall participants preferred the electronic format. CONCLUSIONS When examining equivalence between paper and electronic versions of PROs, formats are usually judged by authors to be equivalent. Participants prefer electronic formats. This literature review gives encouragement to the further widespread development and use of ePROs.
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Affiliation(s)
- Niloufar Campbell
- Centre for Socioeconomic Research, School of Pharmacy and Pharmaceutical Sciences, Cardiff, UK
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Marten-Mittag B, Book K, Buchhold B, Dinkel A, Gründobler B, Henrich G, Huber B, Pirker C, Regenberg A, Schickel S, Senf B, Wünsch A, Herschbach P. The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF)--an expert rating scale for distress screening: development and psychometric properties. Psychooncology 2014; 24:653-60. [PMID: 25346529 DOI: 10.1002/pon.3708] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study is to validate the Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF), a six item interview-based expert rating scale for distress screening in cancer patients. METHODS Using a heterogeneous multicenter study sample (n = 1551), we examined validity, reliability, and dimensionality of the PO-Bado SF. The Hospital Anxiety and Depression Scale (HADS), the Distress Thermometer, the Questionnaire on Stress in Cancer, and the Patient Health Questionnaire were used to investigate convergent validity. Confirmatory factor analysis was applied to address unidimensionality. An optimal cutoff point was determined by ROC analysis and the maximum of Youden's index. An additional study with n = 41 audio recorded PO-Bado SF interviews was carried out to assess inter-rater reliability. RESULTS Mean age of the study sample was 64.0 (SD = 12.0), 42% were women. About 24% of the patients suffered from metastases. The one-factor solution was confirmed; internal consistency of the PO-Bado SF was high (α = 0.84). The PO-Bado SF total score correlated significantly with all psychosocial measures, the highest correlation was with the HADS total score (r = 0.64). Patients with severe disease conditions (metastases, psychological/psychiatric treatment in the past, low performance status) received higher distress ratings (p < 0.001). Using HADS total score (>13) as external criterion, an optimal PO-Bado SF cutoff score of >9 emerged (sensitivity 0.75; specificity 0.82). Inter-rater reliability was satisfactory for each of the six items (intra class correlation of 0.75 to 0.85). CONCLUSIONS The PO-Bado SF is a short, reliable and valid expert rating scale to identify distressed cancer patients.
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Affiliation(s)
- Birgitt Marten-Mittag
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Katrin Book
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Roman-Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Britta Buchhold
- Institute for Medical Psychology, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Dinkel
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bärbel Gründobler
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Gerhard Henrich
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Celia Pirker
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | - Simone Schickel
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bianca Senf
- Universitäres Centrum für Tumorerkrankungen, Universitätsklinikum Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Wünsch
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter Herschbach
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Roman-Herzog Comprehensive Cancer Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Rayner L, Matcham F, Hutton J, Stringer C, Dobson J, Steer S, Hotopf M. Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. Gen Hosp Psychiatry 2014; 36:318-24. [PMID: 24630892 DOI: 10.1016/j.genhosppsych.2013.12.004] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/15/2013] [Accepted: 12/05/2013] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the feasibility and acceptability of routine web-based screening in general hospital settings, and describe the level of common mental disorder. METHOD A service development platform to integrate mental and physical healthcare was implemented in six specialties (rheumatology, limb reconstruction, hepatitis C, psoriasis, adult congenital heart disease (ACHD), chronic pain) across three general hospitals in London, UK. Under service conditions, patients completed a web-based questionnaire comprising mental and physical patient-reported outcome measures, whilst waiting for their appointment. Feasibility was quantified as the proportion of patients who completed the questionnaire. Acceptability was quantified as the proportion of patients declining screening, and the proportion requiring assistance completing the questionnaire. The prevalence of probable depression and anxiety was expressed as the percentage of cases determined by the Patient Health Questionnaire-9 and Generalised Anxiety Disorder Questionnaire-7. RESULTS The proportion of patients screened varied widely across specialties (40.1-98.2%). The decline rate was low (0.6-9.7%) and the minority required assistance (11.7-40.4%). The prevalence of probable depression ranged from 60.9% in chronic pain to 6.6% in ACHD. The prevalence of probable anxiety ranged from 25.1% in rheumatology to 11.4% in ACHD. CONCLUSION Web-based screening is acceptable to patients and can be effectively embedded in routine practice. General hospital patients are at increased risk of common mental disorder, and routine screening may help identify need, inform care and monitor outcomes.
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Affiliation(s)
- L Rayner
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK.
| | - F Matcham
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
| | - J Hutton
- South London and Maudsley and King's College Hospital NHS Foundation Trusts, UK
| | - C Stringer
- Information and Communication Technology, King's College Hospital NHS Foundation Trust, UK
| | - J Dobson
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - S Steer
- Department of Rheumatology, School of Medicine, King's College London, UK
| | - M Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, SE5 9RJ London, UK
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Book K, Dinkel A, Henrich G, Stuhr C, Peuker M, Härtl K, Brähler E, Herschbach P. The effect of including a ‘psychooncological statement’ in the discharge summary on patient-physician communication: a randomized controlled trial. Psychooncology 2013; 22:2789-96. [DOI: 10.1002/pon.3347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/11/2013] [Accepted: 06/12/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Katrin Book
- Roman-Herzog Comprehensive Cancer, Klinikum rechts der Isar; Technische Universität München; Munich Germany
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - Andreas Dinkel
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - Gerhard Henrich
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - Claudia Stuhr
- Clinic for Internal Oncology/Hematology; Leipzig Germany
| | - Mareike Peuker
- Department of Medical Psychology and Medical Sociology; Universitätsklinikum Leipzig AöR; Leipzig Germany
| | - Kristin Härtl
- Department of Gynaecology and Obstetrics; Ludwig-Maximilians-Universität München; Munich Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology; Universitätsklinikum Leipzig AöR; Leipzig Germany
| | - Peter Herschbach
- Roman-Herzog Comprehensive Cancer, Klinikum rechts der Isar; Technische Universität München; Munich Germany
- Division of Psychosocial Oncology, Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar; Technische Universität München; Munich Germany
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Chen J, Ou L, Hollis SJ. A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Serv Res 2013; 13:211. [PMID: 23758898 PMCID: PMC3700832 DOI: 10.1186/1472-6963-13-211] [Citation(s) in RCA: 514] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 05/28/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite growing interest and urges by leading experts for the routine collection of patient reported outcome (PRO) measures in all general care patients, and in particular cancer patients, there has not been an updated comprehensive review of the evidence regarding the impact of adopting such a strategy on patients, service providers and organisations in an oncologic setting. METHODS Based on a critical analysis of the three most recent systematic reviews, the current systematic review developed a six-method strategy in searching and reviewing the most relevant quantitative studies between January 2000 and October 2011 using a set of pre-determined inclusion criteria and theory-based outcome indicators. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to rate the quality and importance of the identified publications, and the synthesis of the evidence was conducted. RESULTS The 27 identified studies showed strong evidence that the well-implemented PROs improved patient-provider communication and patient satisfaction. There was also growing evidence that it improved the monitoring of treatment response and the detection of unrecognised problems. However, there was a weak or non-existent evidence-base regarding the impact on changes to patient management and improved health outcomes, changes to patient health behaviour, the effectiveness of quality improvement of organisations, and on transparency, accountability, public reporting activities, and performance of the health care system. CONCLUSIONS Despite the existence of significant gaps in the evidence-base, there is growing evidence in support of routine PRO collection in enabling better and patient-centred care in cancer settings.
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Affiliation(s)
- Jack Chen
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool 2170NSW, Australia
- Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Randwick 2052, Australia
| | - Lixin Ou
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool 2170NSW, Australia
- Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Randwick 2052, Australia
| | - Stephanie J Hollis
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Liverpool 2170NSW, Australia
- Australian Institute of Health Innovation, Level 1, AGSM Building, University of New South Wales, Randwick 2052, Australia
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Kirchheiner K, Czajka A, Ponocny-Seliger E, Komarek E, Hohenberg G, Pötter R, Dörr W. Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire. Strahlenther Onkol 2013; 189:573-8. [PMID: 23703402 DOI: 10.1007/s00066-013-0348-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/06/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna. MATERIALS AND METHODS The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients' acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs' α. RESULTS Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly-mainly due to organizational problems-and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617. CONCLUSION The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented successfully in clinical routine with benefits for both the patient and the professional team.
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Affiliation(s)
- K Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Kirchheiner K, Czajka A, Ponocny-Seliger E, Lütgendorf-Caucig C, Schmid M, Komarek E, Pötter R, Dörr W. Physical and psychosocial support requirements of 1,500 patients starting radiotherapy. Strahlenther Onkol 2013; 189:424-9. [DOI: 10.1007/s00066-013-0329-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/06/2013] [Indexed: 12/01/2022]
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Nissim R, Wong R, Fyles A, Moddel D, Zimmermann C, Rodin G. Can trained volunteers provide psychosocial support to patients undergoing radiotherapy? The perspective of patients and volunteers. Pract Radiat Oncol 2012; 2:e23-e29. [PMID: 24674181 DOI: 10.1016/j.prro.2011.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Clinic-based psychosocial interventions, including volunteer-based ones, may be a cost-efficient and acceptable means of integrating psychosocial support into cancer care during radiotherapy. The present study evaluated a new psychosocial volunteer support program in a large radiotherapy clinic. METHODS AND MATERIALS Patients were asked to complete a demographic and satisfaction with care questionnaire. Clinic volunteers were asked to report their interactions with patients on shift logs. RESULTS Of the 182 participating patients, 93 (51%) recalled meeting a volunteer in the clinic, with the 2 most common support types provided being the following: "listening and caring," and "information on services." Analysis of 224 volunteers' shift logs indicated that almost all interactions (94%) were initiated by the volunteers, and almost half (47%) involved the patients' companions in the clinic. The most common support type documented was "information and navigation" (71%), followed by "emotional" (47%), "diversional" (21%), and "physical/practical" (17%) support. CONCLUSIONS Trained volunteers can effectively provide clinic-based psychosocial support and information to a high proportion of radiotherapy patients. These findings demonstrate that volunteer support is a feasible means of meeting the psychosocial needs of patients with cancer attending outpatient radiotherapy clinics, who may not require or want professional psychosocial support.
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Affiliation(s)
- Rinat Nissim
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
| | - Rebecca Wong
- Department of Radiation Oncology, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Anthony Fyles
- Department of Radiation Oncology, Ontario Cancer Institute, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Dhara Moddel
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
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Mitchell AJ, Lord K, Slattery J, Grainger L, Symonds P. How feasible is implementation of distress screening by cancer clinicians in routine clinical care? Cancer 2012; 118:6260-9. [PMID: 22674666 DOI: 10.1002/cncr.27648] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 03/08/2012] [Accepted: 03/19/2012] [Indexed: 12/23/2022]
Affiliation(s)
- Alex J Mitchell
- Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom.
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Patient satisfaction during radiation therapy. Strahlenther Onkol 2012; 188:492-8. [DOI: 10.1007/s00066-011-0056-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/23/2011] [Indexed: 10/14/2022]
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