Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

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 Cooperative 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 2 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.3

What is needed by staff to implement PROMs into routine oncology care? A qualitative study with the multi‐disciplinary team

“…All staff agreed that PROMs offered an approach that ensured that patients were central to all communication interactions. This is supported by the published research (Hughes, Wu, Carducci, & Snyder, ; Ito et al, ; Klinkhammer‐Schalke et al, ; Shaw et al, ; Tyson, Greenhalgh, Long, & Flynn, ) which demonstrates that shared knowledge results in better outcomes for patients. Specifically, shared information, rather than information silos, reduces competition for resources between clinician groups, ensuring efficient care (Kislov, Humphreys, & Harvey, ).…”

Advancing psychosocial care in cancer patients

“…Some steps are necessary in order to increase the likelihood that the guidelines are regularly implemented and that distress screening treatment algorithms can be applied 44 , 45 . With respect to this, it is important that, after the screening phase, a more specific evaluation should follow, including a thorough exploration of psychological and behavioural symptoms; this should include previous behavioural health problems, suicidal thoughts, medication use, reliance on substances, and body image and sexuality concerns.…”

Oncologists’ identification of mental health distress in cancer patients: Strategies and barriers

“…It seems that emotional support is key to the effectiveness of these interventions (Mehta & Roth, 2015 To date, the vast majority of research on this topic has looked at the gap between cancer patient's mental health distress and the ability of their healthcare professional to detect it (Rhondali et al, 2015) or has focused on providing guidelines on how to screen and treat cancer patients suffering from mental health distress (Gouveia et al, 2015;Lelorain et al, 2014). To our knowledge, few studies have researched what oncologists look for when screening patients for distress and what, if any, challenges they face in this task (Andersen et al, 2014;Salmon, Clark, Mcgrath, & Fisher, 2015;Shaw et al, 2016;Zebrack et al, 2015). Given that cancer patients often suffer from undetected and thus untreated mental health distress during their treatment trajectory and given the evidence that this treatment gap may be caused by oncologists' difficulty with accurately identifying this distress, this study set out to examine how oncologists approach this issue in their clinical practice.…”