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Taylor J, Fradgley EA, Clinton‐McHarg T, Hall A, Paul CL. Perceived importance of emotional support provided by health care professionals and social networks: Should we broaden our focus for the delivery of supportive care? Asia Pac J Clin Oncol 2023; 19:681-689. [PMID: 36698247 PMCID: PMC10947305 DOI: 10.1111/ajco.13922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/08/2022] [Accepted: 12/26/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Emotional support provided by health care professionals (HCPs) for people diagnosed with cancer is associated with improved outcomes. Support via social networks may also be important. AIMS To report among a sample of distressed patients and caregivers, (1) the importance attributed to different sources of emotional support (HCPs and social networks) by distressed cancer patients and caregivers; (2) the proportion who indicate they did not receive sufficient levels of emotional support; and (3) potential associations between respondents' demographic and clinical characteristics and reported lack of emotional support. METHODS This study utilised cross-sectional data from telephone interviews collected during the usual-care phase of the Structured Triage and Referral by Telephone (START) trial. Participants completed a telephone interview 6 months after their initial call to the Cancer Council Information and Support service and included recall of importance and sufficiency of emotional support. RESULTS More than two-thirds of patients (n = 234) and caregivers (n = 152) reported that family and friends were very important sources of emotional support. Nurses (69% and 42%) and doctors (68% and 47%) were reported very important, while a lower proportion reported that psychologists and psychiatrists were very important (39%, and 43%). Insufficient levels of support were reported by 36% of participants. Perceptions of insufficient support were significantly associated with distress levels (p < .0001) and not having a partner (p = .0115). CONCLUSION Social networks, particularly family, are an important source of emotional support. Higher levels of distress, those without partners, and caregivers may require targeted interventions to increase their access to emotional support.
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Affiliation(s)
- Jo Taylor
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
| | - Elizabeth A. Fradgley
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Cancer Institute New South WalesCancer Institute New South Wales, EveleighSydneyAustralia
| | - Tara Clinton‐McHarg
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- School of PsychologyUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Alix Hall
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
- Hunter New England Population HealthHunter New England Area Health ServiceNewcastleNew South WalesAustralia
| | - Christine L. Paul
- School of Medicine and Public healthUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Health BehaviourUniversity of NewcastleCallaghanNew South WalesAustralia
- Priority Research Centre for Cancer Research Innovation and TranslationUniversity of NewcastleCallaghanNew South WalesAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNewcastleNew South WalesAustralia
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Coppini V, Ferraris G, Monzani D, Grasso R, Pravettoni G. Disparities and barriers in the assessment of psychological distress, access to and use of psycho-oncological support in Europe: current perspectives. Front Psychol 2023; 14:1252843. [PMID: 37794912 PMCID: PMC10546339 DOI: 10.3389/fpsyg.2023.1252843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
The implementation of psycho-oncological support has shown important results in positively influencing treatment outcomes and quality of life in cancer patients and survivors. In the last few decades, the importance of mental health has been brought to attention to the general public and healthcare professionals on a national, institutional and organisational level. Official guidelines, policies, and training programs have been developed suggesting that psycho-oncological support should be considered as a non-negotiable requirement for quality cancer care in many hospitals and clinical centres across Europe. Health organisations, associations, institutions, and societies, such as the International Psycho-Oncology Society (IPOS) and the European Partnership for Action Against Cancer (EPAAC), are forming alliances, funding research projects and organising congresses in order to study, understand, and discuss the reasons for barriers and disparities in psycho-oncological support and, eventually, to overcome the existing cancer divide. Nevertheless, the World Health Organization's (WHO) estimations indicate that the cancer burden is still increasing, and relevant barriers and disparities in accessing psycho-oncological support continue to exist and influence the health conditions and quality of life of cancer patients and survivors. The present work will present the current disparities and barriers regarding assessment, access to and use of psycho-oncological support in the countries of the European Union, making suggestions for further research and possible solutions.
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Affiliation(s)
- Veronica Coppini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giulia Ferraris
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Psychology, Educational Science and Human Movement (SPPEFF), University of Palermo, Palermo, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Cha L, Tevaarwerk AJ, Smith EM, Chandereng T, Huenerberg KJ, Seaborne LA, Carroll CB, Sesto ME. Reported Concerns and Acceptance of Information or Referrals Among Breast Cancer Survivors Seen for Care Planning Visits: Results from the University of Wisconsin Carbone Cancer Center Survivorship Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1702-1710. [PMID: 33904118 PMCID: PMC8546027 DOI: 10.1007/s13187-021-02015-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Breast cancer survivors' experience physical and psychosocial concerns following active curative-intent treatment. Survivors' complex needs are often reviewed at survivorship care planning visits (SCP visits). However, little is known about the post-treatment concerns and resource needs addressed within the context of SCP visits. Using discretely collected electronic health record data, we examined characteristics, concerns, and acceptance of education materials and/or referrals among stages 0-3 breast cancer survivors seen for SCP visits. Most survivors reported concerns related to activity (n = 739; 72.7%) and nutrition (n = 677; 66.6%). Survivors of color were more likely to report concerns related to pain/swelling (odds ratio (OR), 4.4; 95% CI, 1.7-11.4) and employment/insurance (2.8; 1.4-5.7) compared to Whites. More than half accepted materials or referrals for concerns related to nutrition, activity/pain, substance use, sexual health, mood, and sleep (padj-value < 0.05). However, not all reported concerns led to acceptance of materials or referrals. Survivors seen for SCP visits report a wide range of concerns at the end of active curative-intent treatment but may not necessarily accept materials or referrals for their concerns within the context of these visits. Our findings highlight the importance of exercise, physical rehabilitation, and nutrition interventions for survivors following active curative-intent treatment. Further study is needed to elucidate the reasons for acceptance vs. non-acceptance of resources addressing reported concerns.
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Affiliation(s)
- Leah Cha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Amye J Tevaarwerk
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705, USA.
| | | | | | | | | | | | - Mary E Sesto
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
- Department of Medicine, Division of Hematology/Oncology, 6037 Wisconsin Institutes for Medical Research, University of Wisconsin, 1111 Highland Ave, Madison, WI, 53705, USA
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Reading Wishes from the Lips: Cancer Patients' Need for Psycho-Oncological Support during Inpatient and Outpatient Treatment. Diagnostics (Basel) 2022; 12:diagnostics12102440. [PMID: 36292128 PMCID: PMC9600894 DOI: 10.3390/diagnostics12102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/23/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Psycho-oncological support (PO) is an effective measure to reduce distress and improve the quality of life in patients with cancer. Currently, there are only a few studies investigating the (expressed) wish for PO. The aim of this study was to evaluate the number of patients who request PO and to identify predictors for the wish for PO. Methods: Data from 3063 cancer patients who had been diagnosed and treated at a Comprehensive Cancer Center between 2011 and 2019 were analyzed retrospectively. Potential predictors for the wish for PO were identified using logistic regression. As a novelty, a Back Propagation Neural Network (BPNN) was applied to establish a prediction model for the wish for PO. Results: In total, 1752 patients (57.19%) had a distress score above the cut-off and 14.59% expressed the wish for PO. Patients’ requests for pastoral care (OR = 13.1) and social services support (OR = 5.4) were the strongest predictors of the wish for PO. Patients of the female sex or who had a current psychiatric diagnosis, opioid treatment and malignant neoplasms of the skin and the hematopoietic system also predicted the wish for PO, while malignant neoplasms of digestive organs and older age negatively predicted the wish for PO. These nine significant predictors were used as input variables for the BPNN model. BPNN computations indicated that a three-layer network with eight neurons in the hidden layer is the most precise prediction model. Discussion: Our results suggest that the identification of predictors for the wish for PO might foster PO referrals and help cancer patients reduce barriers to expressing their wish for PO. Furthermore, the final BPNN prediction model demonstrates a high level of discrimination and might be easily implemented in the hospital information system.
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Normen M, Sahaya FE, Kulkarni K, Vidhubala E, Shewade HD, Kathiresan J. 'Patients with Cancer are Distressed!' Indian Healthcare Provider Perspectives on Distress Screening and Referrals to Psycho-oncology Services - A Mixed Methods Study. Indian J Palliat Care 2021; 27:561-570. [PMID: 34898952 PMCID: PMC8655644 DOI: 10.25259/ijpc_142_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: Routine screening for distress is a guideline prescribed by the National Comprehensive Cancer Network (NCCN) to adequately assess distress in a cancer setting. Our centre conducted routine screening but failed to utilize psycho-oncology services. Our aim was to assess the extent of self-reported distress, referrals to psycho-oncology services and healthcare provider perspectives about the existing distress management system and psycho-oncology services. Materials and Methods: We conducted a record review of adult patients (n=372) who reported to the Out-patient department of the tertiary cancer centre. Semi-structured interviews were conducted with fourteen healthcare providers. We used a concurrent mixed methods study design. Adult patients were screened for distress using NCCN-Distress Thermometer and problem checklist. Healthcare providers from different oncology specialties were interviewed and the data was analysed using descriptive thematic analysis. Results: Patients screened for distress were found to report moderate to extreme levels of distress (53.5%). The total referrals to psycho-oncology support services were low (8.6%). Interviews with healthcare providers revealed three major themes: Enablers, barriers and solutions for utilization of distress management system and psycho-oncology services. Conclusions: Moderate to extreme distress was found among patients routinely screened for distress, although there was poor utilization of distress management system and psycho-oncology support services due to time constraints, patient’s negative attitudes towards mental health referrals, generic screening tools and use of own clinical judgement to make referrals by healthcare providers. Future research warrants implementation of strategies to integrate psycho-oncology services into routine cancer care by focusing on improving visibility of services.
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Affiliation(s)
- Michelle Normen
- Department of Psycho-Oncology Services, Cytecare Cancer Hospitals, Bengaluru, Karnataka, India
| | | | - Kshitija Kulkarni
- Department of Clinical Operations, Manipal Hospital, Bengaluru, Karnataka, India
| | - E Vidhubala
- Fenivi Research Solutions, Chennai, Tamil Nadu, India
| | - Hemant D Shewade
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Galindo Vázquez O, Rivera S, Lerma A, Calderillo Ruiz G, Espinoza Bello M, Meneses A, Lerma C. Detection of psychosocial distress in cancer patients: A survey of Mexican oncologists. J Psychosoc Oncol 2021; 40:708-723. [PMID: 34845973 DOI: 10.1080/07347332.2021.1986765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose: Identification of patients' distress is relevant for an on-time referral to psychosocial treatment. The objective was to assess the implementation of the guidelines for distress managing in Mexican oncologists based on the NCCN guidelines.Design: The study was non-experimental and cross-sectional.Sample: Two hundred thirty-one oncologists participated with an average age of 38 ± 11 years.Methods: The likelihood of distress assessment was quantitatively evaluated.Findings: A high percentage of oncologists knew and used procedures to assess psychosocial discomfort. However, a smaller percentage used a valid and reliable instrument. Factors associated with performing distress identification procedures were knowing the distress guidelines and lack of time. Factors for questionnaire usage are the availability of brief instruments and the percentage of patients suffering from stress.Implications for Psychosocial Providers: Psychosocial providers should develop strategies to educate and ensure that oncologists are familiar with guidelines on distress in oncology. More dissemination of screening procedures and referral to psychosocial programs in oncology is required. Integrating a distress screening program involving psychosocial providers and oncologists should be approached as a routine in high-quality cancer care, to reduce the stigma associated with mental health services.
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Affiliation(s)
- Oscar Galindo Vázquez
- Service of Psycho-Oncology, Research and Development Unit of Psycho-Oncology, National Cancer Institute of Mexico, INCan, Mexico, Mexico
| | | | - Abel Lerma
- Institute of Health Sciences (ICSa), Autonomous University of the Hidalgo State, Pachuca, Mexico
| | | | | | - Abelardo Meneses
- Psicooncología, National Cancer Institute of Mexico, INCan, Mexico, Mexico
| | - Claudia Lerma
- National Cardiology Institute of Mexico, INCar, Mexico, Mexico
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7
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Klingenstein A, Samel C, Garip-Kuebler A, Priglinger SG, Foerster PI. Screening for Predictive Parameters Requiring Psycho-Oncological Intervention via the National Comprehensive Cancer Network Distress Thermometer in the Follow-Up of Uveal Melanoma Patients. Clin Ophthalmol 2020; 14:3813-3819. [PMID: 33204061 PMCID: PMC7665508 DOI: 10.2147/opth.s276848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/02/2020] [Indexed: 02/03/2023] Open
Abstract
Aim To assess a profile of uveal melanoma patients at risk of requiring active psycho-oncological intervention by employing the National Comprehensive Cancer Network (NCCN) distress thermometer. Methods Multivariate correlation and multiple linear regression analysis of data collected retrospectively from 106 consecutive patients suffering from uveal melanoma. Results Distress levels correlated with practical (p = 0.01), emotional (p = 0.003) and physical problems (p = 0.001) as well as the total number of issues reported (p < 0.001; ANOVA, respectively). Emotional issues added up to 39% of influence on distress levels. Nervousness, worry and sadness as the most important emotional issues tested correlated significantly with anatomic stage, tumor T-category, metastatic status and time after primary diagnosis and were present more frequently in patients with higher distress levels (p < 0.001, p = 0.002, p = 0.004, respectively, Fisher’s exact test). Pre-existing psycho-oncological support was more frequent in metastatic patients and patients with higher anatomic stage tumors (p = 0.008 and p = 0.003; Fisher’s exact test). Conclusion The distress thermometer proved to be useful for rapid assessment of patients requiring active intervention. A higher number of distress items recorded correlated with elevated distress levels. Emotional issues were responsible for the majority of problems. A typical patient profile at risk of developing distress requiring close attention of caregivers includes high anatomic stage, high T-category, presence of metastases and early follow-up. Correct diagnosis and interpretation of distress-levels should help improve the quality of life of uveal melanoma survivors. Trial Registration Not applicable.
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Affiliation(s)
| | - Christina Samel
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | | | - Paul I Foerster
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
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Kayser K, Brydon DM, Moon H, Zebrack B. Institutional capacity to provide psychosocial care in cancer programs: Addressing barriers to delivering quality cancer care. Psychooncology 2020; 29:1995-2002. [DOI: 10.1002/pon.5488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Karen Kayser
- Kent School of Social Work University of Louisville Louisville Kentucky USA
| | - Daphne M. Brydon
- School of Social Work University of Michigan Ann Arbor Michigan USA
| | - Heehyul Moon
- Kent School of Social Work University of Louisville Louisville Kentucky USA
| | - Brad Zebrack
- School of Social Work University of Michigan Ann Arbor Michigan USA
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Ploos van Amstel FK, Peters MEWJ, Donders R, Schlooz-Vries MS, Polman LJM, van der Graaf WTA, Prins JB, Ottevanger PB. Does a regular nurse-led distress screening and discussion improve quality of life of breast cancer patients treated with curative intent? A randomized controlled trial. Psychooncology 2020; 29:719-728. [PMID: 31876036 DOI: 10.1002/pon.5324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We performed a randomized controlled trial (RCT) to investigate whether regular screening with the distress thermometer (DT) by a nurse improved global quality of life (QOL) of patients with breast cancer (BC) treated with curative intent. METHODS BC patients were randomized between regular screening for distress with a nurse-led DT intervention (NDTI) and usual care (UC). Both groups filled out questionnaires at baseline, after each received treatment modality and at follow-up visits up to 2 years. At these points, the intervention group received also the NDTI. The primary outcome was the global QOL of the EORTC QLQ C30 at 2 years after the end of treatment. Analyses were done on an intention-to-treat basis, using analysis of covariance (ANCOVA), generalized least squares, and interaction analyses. RESULTS Of 194 randomized patients, 153 filled out the questionnaires up to 2 years after treatment. There was no significant difference between NDTI and UC in global QOL 2 years after the end of treatment (mean diff. = -1∙273, P = .610; 95% CI [-6.195; 3.649]). Subgroup analysis of patients who received multimodality treatment (surgery, radiotherapy, and chemotherapy, n = 66) showed a significant between-group difference in global QOL over time (mean diff. = -10, P < .001; 95% CI [-14.835; -5.167]) together with other secondary outcome measures in favor of the NDTI. CONCLUSION NDTI did not lead to a significant improvement in global QOL 2 years after the end of treatment for patients with BC. However, the findings indicate that BC patients who received multimodality treatment may benefit from NDTI.
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Affiliation(s)
| | - Marlies E W J Peters
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Lenny J M Polman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petronella B Ottevanger
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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Abstract
PURPOSE OF REVIEW The current review provides an overview of recent research and other initiatives aimed at increasing and/or systematizing screening for distress in cancer survivors. It is timely given an increasing drive internationally to implement distress screening as part of routine cancer care. RECENT FINDINGS Screening using brief validated tools is recommended and the single-item distress thermometer continues to be the international screening tool of choice. Although debate continues regarding the most appropriate cut-off distress thermometer score to identify clinically distressed patients, review of checked items from the accompanying problem list can pinpoint sources of distress, to inform targeted intervention. An integrated approach should include screening, and if required, assessment/referral and intervention. However, whilst distress screening is associated with some impact on referral, especially its timeliness, delivery of evidence-based treatments to address identified distress may be limited by patients declining help and a lack of support services. SUMMARY Although screening for distress in routine care holds promise for reducing costs and enhancing health system efficiency, its implementation across cancer services is variable. Further research is required to evaluate screening implementation and sustainability in routine care, as well as the feasibility of distress screening in long-term cancer survivors who are no longer in regular contact with cancer centres.
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Acquati C, Kayser K. Addressing the psychosocial needs of cancer patients: a retrospective analysis of a distress screening and management protocol in clinical care. J Psychosoc Oncol 2019; 37:287-300. [PMID: 30938622 DOI: 10.1080/07347332.2018.1523822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated. METHODS A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions. RESULTS Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur. Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.
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Affiliation(s)
- Chiara Acquati
- a Graduate College of Social Work , University of Houston , Houston , Texas , USA
| | - Karen Kayser
- b Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA
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Frey Nascimento A, Tondorf T, Rothschild SI, Koller MT, Rochlitz C, Kiss A, Schaefert RM, Meinlschmidt GP, Hunziker S, Gaab J, Zwahlen D. Oncologist recommendation matters!—Predictors of psycho‐oncological service uptake in oncology outpatients. Psychooncology 2018; 28:351-357. [DOI: 10.1002/pon.4948] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/10/2018] [Accepted: 11/15/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Antje Frey Nascimento
- Division of Clinical Psychology and Psychotherapy, Faculty of PsychologyUniversity of Basel Basel Switzerland
| | - Theresa Tondorf
- Division of Clinical Psychology and Psychotherapy, Faculty of PsychologyUniversity of Basel Basel Switzerland
- Medical Oncology DepartmentUniversity Hospital Basel Basel Switzerland
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
| | | | - Michael T. Koller
- Swiss Transplant Cohort Study (STCS)University Hospital Basel Basel Switzerland
| | | | - Alexander Kiss
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
| | - Rainer M. Schaefert
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
- Faculty of MedicineUniversity of Basel Basel Switzerland
| | - Gunther P. Meinlschmidt
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
- Faculty of MedicineUniversity of Basel Basel Switzerland
- Division of Clinical Psychology and Cognitive Behavioral TherapyInternational Psychoanalytic University Berlin Germany
- Division of Clinical Psychology and Epidemiology, Faculty of PsychologyUniversity of Basel Basel Switzerland
| | - Sabina Hunziker
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
- Faculty of MedicineUniversity of Basel Basel Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of PsychologyUniversity of Basel Basel Switzerland
| | - Diana Zwahlen
- Medical Oncology DepartmentUniversity Hospital Basel Basel Switzerland
- Department of Psychosomatic MedicineUniversity Hospital Basel Basel Switzerland
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van Lankveld JJDM, Fleer J, Schroevers MJ, Sanderman R, den Oudsten BL, Dekker J. Recruitment problems in psychosocial oncology research. Psychooncology 2018; 27:2296-2298. [PMID: 29886576 PMCID: PMC6175209 DOI: 10.1002/pon.4792] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Jacques J D M van Lankveld
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, the Netherlands
| | - Joke Fleer
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Joost Dekker
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
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14
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Skaczkowski G, Sanderson P, Shand M, Byrne A, Wilson C. Factors associated with referral offer and acceptance following supportive care problem identification in a comprehensive cancer service. Eur J Cancer Care (Engl) 2018; 27:e12869. [DOI: 10.1111/ecc.12869] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Gemma Skaczkowski
- School of Psychology & Public Health; La Trobe University; Bundoora Vic. Australia
- Olivia Newton-John Cancer Wellness & Research Centre; Austin Health; Heidelberg Vic. Australia
| | - Penelope Sanderson
- Olivia Newton-John Cancer Wellness & Research Centre; Austin Health; Heidelberg Vic. Australia
| | - Melissa Shand
- North Eastern Melbourne Integrated Cancer Service; Melbourne Vic. Australia
| | - Amanda Byrne
- North Eastern Melbourne Integrated Cancer Service; Melbourne Vic. Australia
| | - Carlene Wilson
- School of Psychology & Public Health; La Trobe University; Bundoora Vic. Australia
- Olivia Newton-John Cancer Wellness & Research Centre; Austin Health; Heidelberg Vic. Australia
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15
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Tondorf T, Grossert A, Rothschild S, Koller M, Rochlitz C, Kiss A, Schaefert R, Meinlschmidt G, Hunziker S, Zwahlen D. Focusing on cancer patients' intentions to use psychooncological support: A longitudinal, mixed-methods study. Psychooncology 2018; 27:1656-1663. [PMID: 29656415 PMCID: PMC6001470 DOI: 10.1002/pon.4735] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Distress screening programs aim to ensure appropriate psychooncological support for cancer patients, but many eligible patients do not use these services. To improve distress management, we need to better understand patients' supportive care needs. In this paper, we report the first key finding from a longitudinal study that focused on patients' intentions to use psychooncological support and its association with distress and uptake of the psychooncology service. METHODS We conducted a prospective, observational study in an Oncology Outpatient Clinic and assessed distress, intention to use psychooncological support, and uptake of the psychooncology service by using the Distress Thermometer, a semistructured interview, and hospital records. We analyzed data with a mixed-methods approach. RESULTS Of 333 patients (mean age 61 years; 55% male; 54% Distress Thermometer ≥ 5), 25% intended to use the psychooncology service (yes), 33% were ambivalent (maybe), and 42% reported no intention (no). Overall, 23% had attended the psychooncology service 4 months later. Ambivalent patients reported higher distress than patients with no intention (odds ratio = 1.18, 95% confidence interval [1.06-1.32]) but showed significantly lower uptake behavior than patients with an intention (odds ratio = 14.04, 95% confidence interval [6.74-29.24]). Qualitative analyses revealed that ambivalent patients (maybe) emphasized fears and uncertainties, while patients with clear intentions (yes/no) emphasized knowledge, attitudes, and coping concepts. CONCLUSIONS We identified a vulnerable group of ambivalent patients with high distress levels and low uptake behavior. To optimize distress screening programs, we suggest addressing and discussing patients' supportive care needs in routine clinical practice.
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Affiliation(s)
- T. Tondorf
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
- Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of BaselBaselSwitzerland
| | - A. Grossert
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
- Clinical Psychology and Psychotherapy, Department of PsychologyUniversity of BaselBaselSwitzerland
| | - S.I. Rothschild
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
| | - M.T. Koller
- Swiss Transplant Cohort Study (STCS)University Hospital BaselBaselSwitzerland
| | - C. Rochlitz
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
| | - A. Kiss
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
| | - R. Schaefert
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - G. Meinlschmidt
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
- Division of Clinical Psychology and Epidemiology, Department of PsychologyUniversity of BaselBaselSwitzerland
- Division of Clinical Psychology and Cognitive Behavioral TherapyInternational Psychoanalytic UniversityBerlinGermany
| | - S. Hunziker
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Faculty of MedicineUniversity of BaselBaselSwitzerland
| | - D. Zwahlen
- Department of Psychosomatic MedicineUniversity Hospital BaselBaselSwitzerland
- Department Medical OncologyUniversity Hospital BaselBaselSwitzerland
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16
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Mackenzie L, Carey M, Suzuki E, Yoshimura M, Toi M, D'Este C, Sanson-Fisher R. A cross-sectional study of agreement between the Hospital Anxiety and Depression Scale and patient- and radiation oncologist-reported single-item assessment of depression and anxiety. Psychooncology 2018; 27:1840-1846. [DOI: 10.1002/pon.4736] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Lisa Mackenzie
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine; University of Newcastle; Callaghan NSW Australia
- Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; Newcastle NSW Australia
- Graduate School of Medicine; Kyoto University; Kyoto Japan
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine; University of Newcastle; Callaghan NSW Australia
- Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; Newcastle NSW Australia
| | - Eiji Suzuki
- Breast Surgery; Kyoto University Hospital; Kyoto Japan
| | - Michio Yoshimura
- Department of Radiation Oncology and Image-Applied Therapy; Kyoto University Hospital; Kyoto Japan
| | - Masakazu Toi
- Breast Surgery; Kyoto University Hospital; Kyoto Japan
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health, Research School of Population Health; Australian National University; Canberra ACT Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine; University of Newcastle; Callaghan NSW Australia
- Priority Research Centre for Health Behaviour; University of Newcastle; Callaghan NSW Australia
- Hunter Medical Research Institute; Newcastle NSW Australia
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17
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Cockle-Hearne J, Barnett D, Hicks J, Simpson M, White I, Faithfull S. A Web-Based Intervention to Reduce Distress After Prostate Cancer Treatment: Development and Feasibility of the Getting Down to Coping Program in Two Different Clinical Settings. JMIR Cancer 2018; 4:e8. [PMID: 29712628 PMCID: PMC5952123 DOI: 10.2196/cancer.8918] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background Distress after prostate cancer treatment is a substantial burden for up to one-third of men diagnosed. Physical and emotional symptoms and health service use can intensify, yet men are reticent to accept support. To provide accessible support that can be cost effectively integrated into care pathways, we developed a unique, Web-based, self-guided, cognitive-behavior program incorporating filmed and interactive peer support. Objective To assess feasibility of the intervention among men experiencing distress after prostate cancer treatment. Demand, acceptability, change in distress and self-efficacy, and challenges for implementation in clinical practice were measured. Methods A pre-post, within-participant comparison, mixed-methods research design was followed. Phase I and II were conducted in primary care psychological service and secondary care cancer service, respectively. Men received clinician-generated postal invitations: phase I, 432 men diagnosed <5 years; phase II, 606 men diagnosed <3.5 years. Consent was Web-based. Men with mild and moderate distress were enrolled. Web-based assessment included demographic, disease, treatment characteristics; distress (General Health Questionnaire-28); depression (Patient Health Questionnaire-9); anxiety (General Anxiety Disorder Scale-7); self-efficacy (Self-Efficacy for Symptom Control Inventory); satisfaction (author-generated, Likert-type questionnaire). Uptake and adherence were assessed with reference to the persuasive systems design model. Telephone interviews explored participant experience (phase II, n=10); interviews with health care professionals (n=3) explored implementation issues. Results A total of 135 men consented (phase I, 61/432, 14.1%; phase II, 74/606, 12.2%); from 96 eligible men screened for distress, 32% (30/96) entered the intervention (phase I, n=10; phase II, n=20). Twenty-four completed the Web-based program and assessments (phase I, n=8; phase II, n=16). Adherence for phase I and II was module completion rate 63% (mean 2.5, SD 1.9) versus 92% (mean 3.7, SD 1.0); rate of completing cognitive behavior therapy exercises 77% (mean 16.1, SD 6.2) versus 88% (mean 18.6, SD 3.9). Chat room activity occurred among 63% (5/8) and 75% (12/16) of men, respectively. In phase I, 75% (6/8) of men viewed all the films; in phase II, the total number of unique views weekly was 16, 11, 11, and 10, respectively. The phase II mood diary was completed by 100% (16/16) of men. Satisfaction was high for the program and films. Limited efficacy testing indicated improvement in distress baseline to post intervention: phase I, P=.03, r=−.55; phase II, P=.001, r=−.59. Self-efficacy improved for coping P=.02, r=−.41. Service assessment confirmed ease of assimilation into clinical practice and clarified health care practitioner roles. Conclusions The Web-based program is acceptable and innovative in clinical practice. It was endorsed by patients and has potential to positively impact the experience of men with distress after prostate cancer treatment. It can potentially be delivered in a stepped model of psychological support in primary or secondary care. Feasibility evidence is compelling, supporting further evaluative research to determine clinical and cost effectiveness.
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Affiliation(s)
- Jane Cockle-Hearne
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Deborah Barnett
- Time to Talk, Brighton General Hospital, Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | - James Hicks
- St. Richard's Hospital, Western Sussex Hospitals NHS Trust, Chichester, United Kingdom
| | - Mhairi Simpson
- Access Division - Cancer, NHS Lanarkshire, Monklands Hospital, Airdrie, United Kingdom
| | - Isabel White
- Applied Health Research Group, Department of Psychological Support and Pastoral Care, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
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18
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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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19
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Westhoff PG, de Graeff A, Monninkhof EM, Berveling MJ, van Vulpen M, Leer JWH, Marijnen CAM, Reyners AKL, van der Linden YM. Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress. Acta Oncol 2017; 56:1720-1727. [PMID: 28893119 DOI: 10.1080/0284186x.2017.1374557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD. METHODS Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses. RESULTS At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power. CONCLUSIONS A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.
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Affiliation(s)
- Paulien G. Westhoff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiotherapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelyn M. Monninkhof
- Julius center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maaike J. Berveling
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marco van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem H. Leer
- Department of Radiotherapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna K. L. Reyners
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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