Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines

Butow, Phyllis; Price, Melanie A.; Shaw, Joanne; Turner, Jane; Clayton, Josephine M.; Grimison, Peter; Rankin, Nicole; Kirsten, Laura

doi:10.1002/pon.3920

Cited by 171 publications

(164 citation statements)

References 70 publications

(142 reference statements)

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“…This process differs from that described in distress screening guidelines [11–13] and in recent literature [16, 17] in various ways. First, an important but distinct characteristic is that discussing responses on the screening instrument is considered an integral part of the process; communication takes place with all patients, regardless of a cut-off score.…”

Section: Introductionmentioning

confidence: 93%

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Feasibility of implementing the ‘Screening for Distress and Referral Need’ process in 23 Dutch hospitals

Nuenen

Donofrio

Tuinman

et al. 2016

Support Care Cancer

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PurposeIn the Netherlands, the three-step process ‘Screening for Distress and Referral Need’ (SDRN) was developed for helping identifying, and referring cancer patients suffering from clinically relevant distress or needing a referral. This process includes (1) instrument completion, (2) patient-care provider discussion of the responses, and (3) referral based on 1 and 2. The Netherlands Comprehensive Cancer Organisation, location Groningen (IKNL-G), initiated the implementation of SDRN and developed an implementation roadmap, including procedure and materials. This exploratory study examines the feasibility of SDRN implementation in hospitals, seen from healthcare providers’ perspective, responsible for implementation, and those executing SDRN.MethodsHealthcare providers, from 22 hospitals and from 5 oncology departments of the University Medical Center Groningen (=25 % of Dutch hospitals), evaluated their experiences by responding to a 26-item internet survey.ResultsTwenty-five participants (response = 93 %) completed the survey. SDRN was implemented in 21 hospitals (implementation = 91 %), in two thirds of these hospitals in more than one patient group. Adoption of IKNL-G’s roadmap elements varied between 84 and 100 %. Participants’ average satisfaction score with SDRN was 6.5 (possible range = 0–10, range found = 5–8). Significant positive relationships were found between this satisfaction and participants’ satisfaction with frequency of SDRN (p = 0.02), and keeping logistical agreements (p = 0.04). Participants were dissatisfied with SDRN’s limited current availability to only select patient groups and only certain disease phases.ConclusionsThe implementation of SDRN in daily practice, supported by a pre-developed implementation roadmap, is highly feasible. Continuous attention to SDRN execution, broadening implementation to all forms of cancer, and during the total disease trajectory seems vital to improve healthcare providers’ satisfaction.

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Section: Introductionmentioning

confidence: 93%

“…This is serious, as links have been found between elevated distress levels and reduced health-related quality of life [8], decreased treatment adherence [9], and low satisfaction with care [10]. Consequently, guidelines have been developed to help identify patients suffering from distress and provide them with suitable care [11–13]. …”

Section: Introductionmentioning

confidence: 99%

Feasibility of implementing the ‘Screening for Distress and Referral Need’ process in 23 Dutch hospitals

Nuenen

Donofrio

Tuinman

et al. 2016

Support Care Cancer

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“…Clinical pathways provide evidence-based recommendations to guide best practice and consistent care for specific patient concerns in homogeneous patient groups. Clinical pathways are desirable at a system wide level to allow increased access to an appropriate level of interventions according to the severity of the patients’ symptoms [25]. ‘ADAPT’, or the ‘Anxiety and depression pathway program’, is a large multi-centred clustered implementation RCT funded by Cancer Institute NSW in 2015.…”

Section: Adapt and Development Of Icanadaptmentioning

confidence: 99%

iCanADAPT Early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual

et al. 2017

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BackgroundThis RCT with two parallel arms will evaluate the efficacy of an internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for the treatment of clinical depression and/or anxiety in early stage cancer survivors.Methods/designEarly stage cancer survivors will be recruited via the research arm of a not-for-profit clinical research unit and randomised to an intervention (iCBT) group or a ‘treatment as usual’ (TAU) control group. The minimum sample size for each group is 45 people (assuming effect size > 0.6, power of 80%, and alpha at .05), but 10% more will be recruited to account for attrition. A solitary or cumulative diagnosis(es) of Major Depressive Episode (current), Generalised Anxiety Disorder, Illness Anxiety Disorder, Panic Disorder, Agoraphobia, and/or Adjustment disorder will be determined using modules from the Anxiety Disorders Interview Schedule for DSM-5. Depression and anxiety levels with be measured via the total score of the Hospital Anxiety and Depression scale (HADS-T), the primary outcome measure. Secondary measures will include the Kessler 10 to measure general distress, the Fear of Cancer Recurrence Inventory (FCRI) to measure the specific fear of cancer recurrence and the Functional Assessment of Cancer Therapy, General Version 4 (FACT-G) for self-report of physical, social, emotional and functional well-being. iCBT participants will complete the measures before lessons 1 and 5, at post-treatment and at 3-month follow-up. The TAU group will complete similar measures at weeks 1, 8 and 16 of the waiting period. Program efficacy will be determined using intent-to-treat mixed models. Maintenance of gains will be assessed at 3-month follow-up. Mediation analyses using PROCESS will be used to examine the association between change in depressive and anxious symptoms over time and changes in FCRI and FACT-G QOL in separate analysis.DiscussionThis is the first RCT looking at iCBT specifically for clinical depression and/or anxiety in a cancer population. Findings will help to direct the role of iCBT in streamlined psycho-social care pathways.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12616000231448, registered 19th February 2016 (www.anzctr.org.au). This trial protocol is in compliance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines.

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“…The initial interventions consist of patient education and brief emotional support [9]. The anxiety associated with receiving the diagnosis and associated treatment can be allayed by education and clarifying doubts.…”

Section: Initial Managementmentioning

confidence: 99%

“…Countries such as Australia and the United States have clearly defined clinical practice pathways for the screening and treatment of anxiety and depression [8]. The Australian Guidelines recommend using brief validated screening tools to screen for distress, depression and anxiety in all patients with cancer [9]. The Edmonton Symptom Assessment Scale is a ten item visual analog scale which can be rated by the patient [10].…”

Section: Screening For Distress Anxiety and Depressionmentioning

confidence: 99%

Psychological aspects of cancer

Ratnatunga

Silva

2016

Sri Lanka j Surg

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Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines

Abstract: This clinical pathway will assist cancer services to design their own systems to detect and manage anxiety and depression in their patients, to improve the quality of care.

Cited by 171 publications

References 70 publications

Feasibility of implementing the ‘Screening for Distress and Referral Need’ process in 23 Dutch hospitals

Feasibility of implementing the ‘Screening for Distress and Referral Need’ process in 23 Dutch hospitals

iCanADAPT Early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual

Psychological aspects of cancer

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