Ben Britton

Why do oncology outpatients who report emotional distress decline help

Many patients who experience distress do not seek help, and little is known about the reasons for this. We explored the reasons for declining help among patients who had significant emotional distress.

Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature

PurposeIn addition to cancer-related distress, people with head and neck cancer (HNC) endure facial disfigurement and difficulties with eating and communication. High rates of alcohol use and socio-economic disadvantage raise concerns that patients with HNC may be less likely than others to participate in and adhere to psychological interventions. This article aims to inform future practice and research by reviewing the evidence in support of psychological interventions for this patient group.MethodsWe searched CENTRAL, Medline, Embase, PsycINFO and CINAHL in December 2009. Relevant studies were rated for internal and external validity against the criteria of the Agency for Healthcare Research and Quality (AHRQ) US Preventive Services Task Force. Wherever possible, outcomes were evaluated using effect sizes to confirm statistically significant results and enable comparison between studies. Meta-analysis was planned according to criteria in the Cochrane Handbook for Systematic Reviews. Levels of evidence for each intervention type were evaluated using AHRQ criteria.ResultsNine studies met inclusion criteria. One study was rated ‘good’ for internal validity and four for external validity. Psycho-education and/or cognitive–behavioural therapy were evaluated by seven studies, and communication skills training and a support group by one study each. Significant heterogeneity precluded meta-analysis. Based on a study-by-study review, there was most support for psycho-education, with three out of five studies finding at least some effect.ConclusionsResearch to date suggests it is feasible to recruit people with HNC to psychological interventions and to evaluate their progress through repeated-outcome measures. Evidence for interventions is limited by the small number of studies, methodological problems, and poor comparability. Future interventions should target HNC patients who screen positive for clinical distress and be integrated into standard care.

Effectiveness of QUICATOUCH: a computerised touch screen evaluation for pain and distress in ambulatory oncology patients in Newcastle, Australia

To describe the change in pain and distress over time to demonstrate the effectiveness of the QUICATOUCH program in an outpatient oncology population.

Wellbeing during Active Surveillance for localised prostate cancer: A systematic review of psychological morbidity and quality of life

BACKGROUND Active Surveillance (AS) is recommended for the treatment of localised prostate cancer; however this option may be under-used, at least in part because of expectations of psychological adverse events in those offered or accepting AS. OBJECTIVE (1) Determine the impact on psychological wellbeing when treated with AS (non-comparative studies). (2) Compare AS with active treatments for the impact on psychological wellbeing (comparative studies). METHOD We used the PRISMA guidelines and searched Medline, PsychInfo, EMBASE, CINHAL, Web of Science, Cochrane Library and Scopus for articles published January 2000-2014. Eligible studies reported original quantitative data on any measures of psychological wellbeing. RESULTS We identified 34 eligible articles (n=12,497 individuals); 24 observational, eight RCTs, and two other interventional studies. Studies came from North America (16), Europe (14) Australia (3) and North America/Europe (1). A minority (5/34) were rated as high quality. Most (26/34) used validated instruments, whilst a substantial minority (14/34) used watchful waiting or no active treatment rather than Active Surveillance. There was modest evidence of no adverse impact on psychological wellbeing associated with Active Surveillance; and no differences in psychological wellbeing compared to active treatments. CONCLUSION Patients can be informed that Active Surveillance involves no greater threat to their psychological wellbeing as part of the informed consent process, and clinicians need not limit access to Active Surveillance based on an expectation of adverse impacts on psychological wellbeing.

“You need something like this to give you guidelines on what to do”: patients' and partners' use and perceptions of a self-directed coping skills training resource

PurposeThis study aims to report on the acceptability of a self-directed coping skills intervention, called Coping-Together, for patients affected by cancer and their partners, including the strengths and limitations of the intervention design.MethodsThis initial version of Coping-Together included a series of four booklets, which aimed to provide practical coping strategies for the day-to-day management of common physical and psychosocial challenges. Thirty semi-structured interviews were conducted with 27 patients and/or 14 partners. Interviews were audiorecorded, transcribed verbatim, and analyzed for content.ResultsParticipants endorsed the self-directed format, and the focus of Coping-Together on practical information was a feature that set it apart from other resources. The majority of participants interviewed felt that the proposed coping strategies were “doable”; however, only half of the participants reported learning new coping skills after reading the booklets. Additional benefits of reading the booklets were increasing awareness of challenges to prepare for, giving hope that something can help you “pull through”, providing a sense of normality, connecting patients and partners to people and services, and complementing support received from health professionals. Despite the general acceptability of the intervention, some aspects of its design were criticized, including the workbook-like exercises, expectations about using the resource together, level of guidance provided, and amount of information included. In general, most participants felt that too much negative information was included, whereas more experiential information was desired.ConclusionsPreliminary evaluation of Coping-Together supported its practical approach and highlighted improvements to enhance its contribution to patient and partner coping.

Eating As Treatment (EAT) study protocol: a stepped-wedge, randomised controlled trial of a health behaviour change intervention provided by dietitians to improve nutrition in patients with head and neck cancer undergoing radiotherapy

Introduction Maintaining adequate nutrition for Head and Neck Cancer (HNC) patients is challenging due to both the malignancy and the rigours of radiation treatment. As yet, health behaviour interventions designed to maintain or improve nutrition in patients with HNC have not been evaluated. The proposed trial builds on promising pilot data, and evaluates the effectiveness of a dietitian-delivered health behaviour intervention to reduce malnutrition in patients with HNC undergoing radiotherapy: Eating As Treatment (EAT). Methods and analysis A stepped-wedge cluster randomised design will be used. All recruitment hospitals begin in the control condition providing treatment as usual. In a randomly generated order, oncology staff at each hospital will receive 2 days of training in EAT before switching to the intervention condition. Training will be supplemented by ongoing supervision, coaching and a 2-month booster training provided by the research team. EAT is based on established behaviour change counselling methods, including motivational interviewing, cognitive–behavioural therapy, and incorporates clinical practice change theory. It is designed to improve motivation to eat despite a range of barriers (pain, mucositis, nausea, reduced or no saliva, taste changes and appetite loss), and to provide patients with practical behaviour change strategies. EAT will be delivered by dietitians during their usual consultations. 400 patients with HNC (nasopharynx, hypopharynx, oropharynx, oral cavity or larynx), aged 18+, undergoing radiotherapy (>60 Gy) with curative intent, will be recruited from radiotherapy departments at 5 Australian sites. Assessments will be conducted at 4 time points (first and final week of radiotherapy, 4 and 12 weeks postradiotherapy). The primary outcome will be a nutritional status assessment. Ethics and dissemination Ethics approval from all relevant bodies has been granted. Study findings will be disseminated widely through peer-reviewed publications and conference presentations. Trial registration number ACTRN12613000320752.

Predictors of desire for help in oncology outpatients reporting pain or distress.

Although effective treatments for pain and distress are available, many patients do not access them. Improved understanding of patients’ desire for help may improve uptake of services.

Intelligent obesity interventions using Smartphones

Recent advances in communication technology have equipped cell phones with digital cameras, internet connectivity, advanced computing capabilities, motion sensors and Global Positioning Systems (GPS) (Moren, 2009). The development of this ‘Smartphone’ technology may represent a new frontier for obesity prevention and management. Smartphone delivered interventions promise access to large numbers of obese persons. Globally, Smartphone sales are expected to exceed 1.5 billion over the next 5 years (Whitney, 2009). In the U.S, there are over 26 million Smartphone subscribers, with subscription increasing from 10 to 17% between 2008 and 2009 (Quick 2009). Subscription rates in other developed countries such as Italy (28%) and Spain (23%) are even higher (Quick 2009). Once developed, interventions utilizing Smartphone applications can be internationally accessible to other Smartphone users over the web. Smartphones represent a modality capable of delivering best practice obesity intervention (National Obesity Observatory, 2010). Indeed, the use of Smartphone technology has been suggested as a means to address many of the failings of previous obesity interventions and increase compliance with, and effectiveness of, behavioral weight management strategies (Tufano and Karras, 2005). Like internet delivered interventions, behavioral support can be individualized and delivered in multiple and interactive formats. The portability of Smartphones may also facilitate behavioral self monitoring. For example, nutrition software could permit users to quickly identify the nutritional properties of foods at the time food selection is taking place, cumulatively count energy intake against a daily goal and provide an opportunity to adjust food preferences accordingly. Further, accessing social networking sites or receiving SMS text messages or emails via Smartphones may facilitate social support and maintenance of behavior change. Perhaps the more novel and potentially potent prevention and treatment strategies involve the integration of Smartphone capabilities such as GPS, motion sensors and internet connectivity. Such integration, for example, could be used to automate shopping lists based on the selection of healthy recipes during meal planning, and prompt users with a list of required ingredients when in the vicinity of relevant grocery stores. Similarly, Smartphone software can utilize motion sensors and GPS to create maps of exercise routes and provide users with real-time feedback regarding movement speed, step counts, energy expenditure and the completion of exercise goals.

Smoking cessation care among patients with head and neck cancer: a systematic review

Objective To examine the effectiveness of smoking cessation interventions in improving cessation rates and smoking related behaviour in patients with head and neck cancer (HNC). Design A systematic review of randomised and non-randomised controlled trials. Methods We searched the following data sources: CENTRAL in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL up to February 2016. A search of reference lists of included studies and Google Scholar (first 200 citations published online between 2000 and February 2016) was also undertaken. The methodological quality of included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). 2 study authors independently screened and extracted data with disagreements resolved via consensus. Results Of the 5167 studies identified, 3 were eligible and included in the review. Trial designs of included studies were 2 randomised controlled trials and 1 non-randomised controlled trial. 2 studies received a weak methodological rating and 1 received a moderate methodological rating. The trials examine the impact of the following interventions: (1) nurse delivered cognitive–behaviour therapy (CBT) via telephone and accompanied by a workbook, combined with pharmacotherapy; (2) nurse and physician brief advice to quit and information booklets combined with pharmacotherapy; and (3) surgeon delivered enhanced advice to quit smoking augmented by booster sessions. Only the trial of the nurse delivered CBT and pharmacotherapy reported significant increases in smoking cessation rates. 1 study measured quit attempts and the other assessed consumption of cigarettes per day and readiness to change. There was no significant improvement in quit attempts or cigarettes smoked per day among patients in the intervention groups, relative to control. Conclusions There are very few studies evaluating the effectiveness of smoking cessation interventions that report results specific to the HNC population. The 3 trials identified reported equivocal findings. Extended CBT counselling coupled with pharmacotherapy may be effective. Trial registration number CRD42016016421.

Fidelity considerations in translational research: Eating As Treatment — a stepped wedge, randomised controlled trial of a dietitian delivered behaviour change counselling intervention for head and neck cancer patients undergoing radiotherapy

BackgroundThe confidence with which researchers can comment on intervention efficacy relies on evaluation and consideration of intervention fidelity. Accordingly, there have been calls to increase the transparency with which fidelity methodology is reported. Despite this, consideration and/or reporting of fidelity methods remains poor. We seek to address this gap by describing the methodology for promoting and facilitating the evaluation of intervention fidelity in The EAT (Eating As Treatment) project: a multi-site stepped wedge randomised controlled trial of a dietitian delivered behaviour change counselling intervention to improve nutrition (primary outcome) in head and neck cancer patients undergoing radiotherapy.Methods/DesignIn accordance with recommendations from the National Institutes of Health Behaviour Change Consortium Treatment Fidelity Workgroup, we sought to maximise fidelity in this stepped wedge randomised controlled trial via strategies implemented from study design through to provider training, intervention delivery and receipt. As the EAT intervention is designed to be incorporated into standard dietetic consultations, we also address unique challenges for translational research.DiscussionWe offer a strong model for improving the quality of translational findings via real world application of National Institutes of Health Behaviour Change Consortium recommendations. Greater transparency in the reporting of behaviour change research is an important step in improving the progress and quality of behaviour change research.Trial registration numberACTRN12613000320752 (Date of registration 21 March 2013)