Nicole Rankin

A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses.

ObjectiveThe objective of this paper is to inform choice of optimal patient-reported outcome measures (PROMs) of anxiety, depression and general distress for studies evaluating psychosocial interventions for English-speaking adults with heterogenous cancer diagnoses.MethodsA systematic review was conducted to identify all PROMs used to assess anxiety, depression and general distress in randomised controlled trials (RCTs) of psychosocial interventions for people with cancer published between 1999 and May 2009. Candidate PROMs were evaluated for content, evidence of reliability and validity, clinical meaningfulness, comparison data, efficiency, ease of administration, cognitive burden and track record in identifying treatment effects in RCTs of psychosocial interventions. Property ratings were weighted and summed to give an overall score out of 100.ResultsThe Hospital Anxiety and Depression Scale (HADS) scored highest overall (weighted score = 77.5), followed by the unofficial short-form of the Profile of Mood States (POMS), the POMS-37 (weighted score = 60), and the Centre for Epidemiological Studies Depression Scale (CES-D) and original POMS (weighted score = 55 each).ConclusionsThe HADS’ efficiency and substantial track record recommend its use where anxiety, mixed affective disorders or general distress are outcomes of interest. However, continuing controversy concerning the HADS depression scale cautions against dependence where depressive disorders are of primary interest. Where cost is a concern, the POMS-37 is recommended to measure anxiety or mixed affective disorders but does not offer a suitable index of general distress and, like the HADS, emphasises anhedonia in measuring depression. Where depression is the sole focus, the CES-D is recommended.

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.

The use and acceptability of a one-on-one peer support program for Australian women with early breast cancer

A population-based survey of Australian women diagnosed with early breast cancer examined the uptake and acceptability of a peer support program, the Breast Cancer Support Service (BCSS). We examined the characteristics and perceptions of women who did and did not use the BCSS. More than one-third (36%) had used the BCSS, most of whom first heard of it from hospital staff (36%) or clinicians (16%). Women perceived meeting someone else with similar experiences (53%) as the most beneficial aspect of the program and 89% said they would definitely recommend it to others. The findings suggest that uptake is related to provision of information about the BCSS. Peer support programs appear to be acceptable to both women who do and do not use the BCSS. To ensure that women can choose whether to participate in peer support programs requires strategies that encourage health professionals to provide comprehensive supportive care information.

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

A clinical pathway for anxiety and depression in adult cancer patients was developed to guide best practice in Australia.

Are specialist breast nurses available to Australian women with breast cancer

Despite evidence of benefit, little is know about Australian womens access to and perceptions of specialist breast nurse (SBN) care. The aims of this study were to: explore access to SBNs by Australian women with breast cancer; identify factors associated with receiving systematic SBN care (at least 3 SBN contacts including preoperatively and postoperatively and at follow-up); and explore the impact of systematic SBN care on womens perceptions of treatment and support. A population-based sample of 544 women with early breast cancer was randomly selected through state and territory cancer registries. Participants completed a structured telephone interview. Over half (52%) of the women had no SBN contact and only 11% received systematic SBN care. Factors associated with systematic SBN care were being treated in a public hospital and receiving systemic adjuvant therapy. Women who received systematic SBN care were more likely to report receiving enough support for themselves and their families, and enough information about where to get more support or counseling and the costs of treatment. In conclusion, systematic SBN contact was uncommon in this population-based sample but positively influenced womens perceptions of care, particularly in relation to the provision of support.

Adapting the nominal group technique for priority setting of evidence-practice gaps in implementation science

BackgroundThere are a variety of methods for priority setting in health research but few studies have addressed how to prioritise the gaps that exist between research evidence and clinical practice. This study aimed to build a suite of robust, evidence based techniques and tools for use in implementation science projects. We applied the priority setting methodology in lung cancer care as an example.MethodsWe reviewed existing techniques and tools for priority setting in health research and the criteria used to prioritise items. An expert interdisciplinary consensus group comprised of health service, cancer and nursing researchers iteratively reviewed and adapted the techniques and tools. We tested these on evidence-practice gaps identified for lung cancer. The tools were pilot tested and finalised. A brief process evaluation was conducted.ResultsWe based our priority setting on the Nominal Group Technique (NGT). The adapted tools included a matrix for individuals to privately rate priority gaps; the same matrix was used for group discussion and reaching consensus. An investment exercise was used to validate allocation of priorities across the gaps. We describe the NGT process, criteria and tool adaptations and process evaluation results.ConclusionsThe modified NGT process, criteria and tools contribute to building a suite of methods that can be applied in prioritising evidence-practice gaps. These methods could be adapted for other health settings within the broader context of implementation science projects.

Evidence‐practice gaps in lung cancer: A scoping review

Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

Views of psycho-oncology health professionals on priority psycho-oncology research questions

PurposeThere is a need for periodic review of research priorities in psycho-oncology. The purpose of this research was to conduct a qualitative study designed to canvass the views of health professionals working in psycho-oncology in Australia regarding current priority areas for research in psycho-oncology.MethodsThis study was conducted in two phases. This article reports the results from the first phase, where focus groups were conducted with key researchers and clinicians active in psycho-oncology.ResultsA total of 55 individuals took part in ten focus groups and two interviews. Participants identified 12 priority areas for research. These areas were grouped into four global themes given a significant overlap in the research issues identified. The four global themes are: distress—improving identification, detection, referral and management; specific populations requiring intervention research; the patient journey; and health services research. Key issues identified for each theme are documented along with participant quotes.ConclusionsThis research provides the first steps in identifying research priorities in psycho-oncology and will guide the development of pertinent research studies as well as inform collaborative research studies focusing on clinically relevant interventions. The outcomes of such studies should ultimately guide optimal patient care.

Psychosocial oncology services in New South Wales

There is limited published evidence about how psychosocial services should be organised or routinely integrated into cancer services to ensure that cancer patients receive appropriate psychological, social and emotional support during periods of diagnosis, treatment and follow-up. This paper reports on a survey of 26 oncology services in New South Wales, Australia, to examine the current provision of psychosocial oncology services. The aim of the study was to gather baseline data and information about the provision of services and to identify significant challenges associated with the development and implementation of psychosocial oncology services. A total of 42% of staff at psycho-oncology services reported they could provide adequate psycho-oncology services, but 58% of sites said they could provide either only limited (27%) or very limited (31%) services. We found that services frequently identified challenges such as insufficient funding to employ skilled staff to provide psychosocial interventions, inadequate data to demonstrate the effectiveness of psychosocial interventions and, at times, lack of space to allow privacy for patient consultations. Future needs identified were strategic planning of psychosocial oncology services as part of broader cancer service plans, leadership of psychosocial oncology services, cohesive teams using agreed patient pathways or tools and integration into multi-disciplinary cancer teams.

Closing evidence‐practice gaps in lung cancer: Results from multi‐methods priority setting in the clinical context

To establish priorities for implementation research to reduce evidence‐practice gaps in lung cancer care.