The Hospital Anxiety and Depression Scale (HADS), a four-point, 14-item questionnaire, was tested as a screening method for adjustment disorders and major depressive disorders in a sample of 210 cancer in-patients. A receiver operating characteristic (ROC) analysis was performed, giving the relationship between the true positive rate (sensitivity) and the false positive rate (1-specificity). This makes it possible to choose an optimal cut-off point that takes into account the costs and benefits of treatment of psychological distress. For screening for major depressive disorders only, a cut-off score of 19 gave 70% sensitivity and 75% specificity. For screening for adjustment disorders and major depressive disorders taken together, a cut-off score of 13 gave 75% sensitivity and 75% specificity. HADS appears in this study to be a simple, sensitive and specific tool for screening for psychiatric disorders in an oncology in-patient population.

There is today a wide consensus regarding the need to improve communication skills (CS) of health-care professionals (HCPs) dealing with cancer patients. Psychological training programs (PTPs) may be useful to acquire the needed CS. Testing the efficacy of PTP will allow to define their optimal content. The present study was designed to assess the impact of a PTP on HCP stress, attitudes and CS, and on HCP and patients' satisfaction with HCP communication skills in a randomised study. A total of 115 oncology nurses were randomly assigned to a 105-h PTP or to a waiting list. Stress was assessed with the Nursing Stress Scale, attitudes with a Semantic Differential Questionnaire, CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual, and satisfaction with the nurses' CS with a questionnaire completed by the patients and the nurses. Trained (TG) and control (CG) groups were compared at baseline, after 3 months (just following training for TG) and after 6 months (3 months after the end of training for TG). Compared to controls, trained nurses reported positive changes on their stress levels (Pp0.05) and on their attitudes (Pp0.05). Positive training effects were found on CS used during the simulated interview: a significant increase in facilitative behaviours (open questions: Pp0.001; evaluative functions: Pp0.05) and a significant decrease in inhibitory behaviours (inappropriate information: Pp0.01; false reassurance: Pp0.05). Less positive training effects were found regarding interviews with a cancer patient: a significant increase in educated guesses (Pp0.001) was noticed. No training effect was observed on nurses' satisfaction levels, but a positive training effect was found on patients' satisfaction levels (Pp0.01). Although results outline PTP efficacy, they indicate the need to design PTP, amplifying the transfer of learned CS to clinical practice.

The emotional content of health care professionals -cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy. One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods. Nurses randomly allocated to a control group arm (waiting list) were assessed a first time and then 3 and 6 months later. Nurses allocated to the training group were assessed before training workshop, just after and 3 months later. Each nurse completed a 20-min clinical and simulated interview. Each interview was analysed by three content analysis systems: two computer-supported content analysis of emotional words, the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level, the Cancer Research Campaign Workshop Evaluation Manual. The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained (P=0.056): training group subjects use 4.3 (std: 3.7) emotional words per 1000 used before training workshop, and 7.0 (std: 5.8) right after training workshop and 5.9 (std: 4.3) 3 months later compared to control group subjects which use 4.5 (std: 4.8) emotional words at the first assessment point, 4.3 (std: 4.1) at the second and 4.4 (std: 3.3) at the third. The same trend is noticeable for emotional words used by health care professionals in simulated interviews (P=0.000). The emotional words registry used by health care professionals however remains stable over time in clinical interviews (P=0.141) and is enlarged in simulated interviews (P=0.041). This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training (P=0.005). This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression. It has been often hypothesized that empathy and the facilitation of CP expression of emotional concerns/distress is one of the factors which may improve the quality of HCP communication. HCP usually block CP expression of emotional concerns/distress and are often unable to clarify CP emotional concerns/distress not only because they fear to acknowledge emotions but also because they feel uncomfortable speaking about emotions when they are openly expressed (Razavi et al, 2000). This discomfort is also related to HCP difficulty to deal with their own emotions and to their attempt to suppress their own emotions.There is a need to better understand the expression of emotional concerns/distress in the context of HCP -CP communication. Moreover, there is a need to help HCP to cope with his own and others emotions, to facilitate acknowledgment of emotions, and to clarify emotio...

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The present paper reports on the initial development of a comprehensive questionnaire for assessing cancer patients' perception of the quality of care received in the oncology hospital. This questionnaire is primarily intended to evaluate interventions aimed at improving quality of life and focuses on patients' interactions with doctors and nurses. The current questionnaire includes 61 items assessing doctors' and nurses' technical competence, communication skills, interpersonal qualities, and availability; aspects of the hospital environment and treatment planning; and general satisfaction. Most items refer to an aspect of care rated on a five-point Likert scale from "Poor" to "Excellent". Additionally, each aspect of care is also evaluated by a dichotomous (yes/no) question on the patient's wish (or not) for its improvement. This questionnaire is the result of consecutive pilot tests (from April 1994 to September 1995). Analysis of patients' comments, items that patients omitted to respond to and score distributions have identified items needing to be rephrased, reworded, eliminated or placed in specific sections. Items showing low scores or acceptable score distributions have been stressed as appropriate for inclusion in the final questionnaire version.