Developing a Clinical Pathway for the Identification and Management of Anxiety and Depression in Adult Cancer Patients: an Online Delphi Consensus Process

Overview

Journal Support Care Cancer

Specialties Critical Care
Oncology

Date 2015 Apr 24

PMID 25903929

Citations 19

Authors

Joanne M Shaw

Melanie A Price

Josephine M Clayton

Peter Grimison

Tim Shaw

Nicole Rankin

Phyllis N Butow

Affiliations

Soon will be listed here.

Abstract

Purpose: People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context.

Methods: A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80% of respondents scoring within 2 points on the Likert scale.

Results: Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings.

Conclusions: This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.

Citing Articles

Fidelity and acceptability of implementation strategies developed for adherence to a clinical pathway for screening, assessment and management of anxiety and depression in adults with cancer.

He S, Shepherd H, Butow P, Shaw J, Harris M, Faris M Arch Public Health. 2024; 82(1):65.

PMID: 38711115 PMC: 11071180. DOI: 10.1186/s13690-024-01293-6.

Perceptions and Current Practices in Patient-Centered Care: A Qualitative Study of Ryan White HIV Providers in South Florida.

Knight J, Ward M, Fernandez S, Genberg B, Beach M, Ladner R J Int Assoc Provid AIDS Care. 2024; 23:23259582241244684.

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Identification of an oncological clinical pathway through questionnaires to health professionals.

Forrester M, Breitenfeld L, Castelo-Branco M, Aperta J BMC Health Serv Res. 2023; 23(1):1011.

PMID: 37726812 PMC: 10510255. DOI: 10.1186/s12913-023-09964-w.

Effect of core versus enhanced implementation strategies on adherence to a clinical pathway for managing anxiety and depression in cancer patients in routine care: a cluster randomised controlled trial.

Butow P, Faris M, Shaw J, Kelly P, He S, Harris M Implement Sci. 2023; 18(1):18.

PMID: 37217928 PMC: 10204284. DOI: 10.1186/s13012-023-01269-0.

Towards a novel approach guiding the decision-making process for anticancer treatment in patients with advanced cancer: framework for systemic anticancer treatment with palliative intent.

Ribi K, Kalbermatten N, Eicher M, Strasser F ESMO Open. 2022; 7(3):100496.

PMID: 35597176 PMC: 9271509. DOI: 10.1016/j.esmoop.2022.100496.

References

Mitchell A, Kaar S, Coggan C, Herdman J . Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non-specialists. Psychooncology. 2007; 17(3):226-36. DOI: 10.1002/pon.1228. View

Akins R, Tolson H, Cole B . Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC Med Res Methodol. 2005; 5:37. PMC: 1318466. DOI: 10.1186/1471-2288-5-37. View

Dudgeon D, King S, Howell D, Green E, Gilbert J, Hughes E . Cancer Care Ontario's experience with implementation of routine physical and psychological symptom distress screening. Psychooncology. 2011; 21(4):357-64. DOI: 10.1002/pon.1918. View

Newell S, Sanson-Fisher R, Girgis A, Bonaventura A . How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer. 1998; 83(8):1640-51. View

Loscalzo M, Clark K, Holland J . Successful strategies for implementing biopsychosocial screening. Psychooncology. 2011; 20(5):455-62. DOI: 10.1002/pon.1930. View

Carlson L, Groff S, Maciejewski O, Bultz B . Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010; 28(33):4884-91. DOI: 10.1200/JCO.2009.27.3698. View

Jacobsen P . Screening for psychological distress in cancer patients: challenges and opportunities. J Clin Oncol. 2007; 25(29):4526-7. DOI: 10.1200/JCO.2007.13.1367. View

Rotter T, Kinsman L, James E, Machotta A, Gothe H, Willis J . Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev. 2010; (3):CD006632. DOI: 10.1002/14651858.CD006632.pub2. View

Mitchell A, Chan M, Bhatti H, Halton M, Grassi L, Johansen C . Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011; 12(2):160-74. DOI: 10.1016/S1470-2045(11)70002-X. View

10.

Kadan-Lottick N, Vanderwerker L, Block S, Zhang B, Prigerson H . Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer. 2005; 104(12):2872-81. PMC: 1459283. DOI: 10.1002/cncr.21532. View

11.

Vanhaecht K, De Witte K, Panella M, Sermeus W . Do pathways lead to better organized care processes?. J Eval Clin Pract. 2009; 15(5):782-8. DOI: 10.1111/j.1365-2753.2008.01068.x. View

12.

Luckett T, Butow P, King M . Improving patient outcomes through the routine use of patient-reported data in cancer clinics: future directions. Psychooncology. 2009; 18(11):1129-38. DOI: 10.1002/pon.1545. View

13.

Panella M, Marchisio S, Di Stanislao F . Reducing clinical variations with clinical pathways: do pathways work?. Int J Qual Health Care. 2003; 15(6):509-21. DOI: 10.1093/intqhc/mzg057. View

14.

Rankin N, Butow P, Thein T, Robinson T, Shaw J, Price M . Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer. BMC Health Serv Res. 2015; 15:28. PMC: 4307637. DOI: 10.1186/s12913-015-0691-9. View

15.

Walker J, Sawhney A, Holm Hansen C, Ahmed S, MARTIN P, Symeonides S . Treatment of depression in adults with cancer: a systematic review of randomized controlled trials. Psychol Med. 2013; 44(5):897-907. DOI: 10.1017/S0033291713001372. View

16.

Green B, Jones M, Hughes D, Williams A . Applying the Delphi technique in a study of GPs' information requirements. Health Soc Care Community. 2001; 7(3):198-205. DOI: 10.1046/j.1365-2524.1999.00176.x. View

17.

Bruera E, Kuehn N, Miller M, Selmser P, Macmillan K . The Edmonton Symptom Assessment System (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care. 1991; 7(2):6-9. View

18.

Carlson L, Waller A, Mitchell A . Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol. 2012; 30(11):1160-77. DOI: 10.1200/JCO.2011.39.5509. View

19.

Howell D, Hack T, Oliver T, Chulak T, Mayo S, Aubin M . Survivorship services for adult cancer populations: a pan-Canadian guideline. Curr Oncol. 2011; 18(6):e265-81. PMC: 3224035. DOI: 10.3747/co.v18i6.956. View

20.

Subnis U, Starkweather A, McCain N, Brown R . Psychosocial therapies for patients with cancer: a current review of interventions using psychoneuroimmunology-based outcome measures. Integr Cancer Ther. 2013; 13(2):85-104. DOI: 10.1177/1534735413503548. View