Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?

Abstract

Implementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance.

Exploring associations between psychiatric disorder, psychological distress, and health care utilization in cancer patients

“…Although the percentage of patients with psychiatric disorder having received mental health care was higher than reported previously (57.3 vs 43.6), about half of patients with psychiatric disorder did not use mental health care. This is in line with research demonstrating that there is no one‐on‐one relationship between positive screen for psychological distress and subsequent wish for or use of mental health care . For example, distressed patients could also choose to rely on family or prefer to not talk about it .…”

Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms

“…In our study, almost one in three depressed persons reported no need or time for treatment. Several studies have drawn similar conclusions that cancer patients with elevated symptoms did not want a referral . Possible reasons that have been identified include patients' desire to manage problems on their own or by means of informal social support, which may be related to fear of stigmatization for visiting a psychologist .…”

“…Only 1.0% of the approached individuals participated in the RCT. Several other trials on psychological outcomes in oncology also found low inclusion rates between 2.5% and 3.5% . Above‐mentioned trials and our trial used consecutive sampling for patient recruitment, which encompasses systematically screening every individual who meets the selection criteria .…”

“…For this reason, consecutive sampling is generally seen as the golden standard and is favorable to convenience sampling, because the latter is more prone to selection bias . However, in practice, this may not completely be the case, because a recent trial found that consecutive sampling still resulted in considerable selection bias in terms of enrolling predominantly young and highly educated patients . Moreover, consecutive sampling is not mandated in the CONSORT guidelines (recommendations for high‐quality reporting of RCTs in order to maintain high internal validity) implying that consecutive sampling is not a preferred method to convenience sampling for trial recruitment.…”

Recruitment problems in psychosocial oncology research

“…Methodological factors include the use of screening instruments that have low predictive validity and do not succeed in identifying those patients who desire supportive psychosocial care, as well as inefficient procedures for approaching cancer survivors. An example of the first factor was provided by van Scheppingen and colleagues who conducted an RCT investigating the efficacy of problem‐solving therapy for cancer survivors. They reported that screening based on symptom checklist scores and 1 additional question on need for services proved unsuccessful for recruiting sufficient cancer patients in need of care.…”