Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients’ and clinicians’ perspectives on communication about distress

Abstract

BackgroundInternational standards prioritize introducing routine emotional distress screening in cancer care to accurately identify patients who most need psycho-oncological treatment, and ensure that patients can access appropriate supportive care. However, only a moderate proportion of distressed patients accepts referrals to or uses psycho-oncological support services. Predictors and barriers to psycho-oncological support service utilization are under-studied. We know little about how patients and oncologists perceive the discussions when oncologists assess psychosocial distress with a screening instrument.We aim to 1) assess the barriers and predictors of uptake of in-house psycho-oncological support along the distress screening pathway in cancer patients treated at a University Oncology Outpatient Clinic and, 2) determine how patients and clinicians perceive communication about psychosocial distress after screening with the Distress Thermometer.MethodsThis is a quantitative prospective observational study with qualitative aspects. We will examine medical and demographic variables, cancer patient self-reports of various psychological measures, and aspects of the patient-clinician communication as variables that potentially predict uptake of psycho-oncological support service. We will also assess the patients’ reasons for accepting or refusing psycho-oncological support services. We assess at three points in time, based on paper-and-pencil questionnaires and two patient interviews during the study period. We will monitor outcomes (psycho-oncology service uptake) four months after study entry.DiscussionThe study will improve our understanding of characteristics of patients who accept or refuse psycho-oncological support, and help us understand how patients’ and oncologists perceive communication about psychosocial distress, and referral to a psycho-oncologist. We believe this is the first study to focus on factors that affect uptake or rejection of psycho-oncological support services along the screening and referral pathway. The study 1) combines standard assessment with qualitative data collection, 2) embraces patient and oncologist perspectives, and, 3) focuses on patient-clinician communication about psychosocial issues raised by a standard screening instrument.Our results may improve routine practices and eliminate barriers to adequate health care, and make it easier to recognize patients with high distress levels who underuse the service.

Focusing on cancer patients' intentions to use psychooncological support: A longitudinal, mixed‐methods study

“…We report findings from a prospective, observational study in the Oncology Outpatient Clinic of the University Hospital Basel (Switzerland). Our methods are briefly outlined below; we have described them in more detail elsewhere …”

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

“…In Switzerland, a study investigating the barriers and predictors of patients accepting or declining psycho-oncological support has recently opened. The results of this trial should increase the insight into why not all patients with PD want to be referred for an intervention [38].…”

A cross‐sectional study of agreement between the Hospital Anxiety and Depression Scale and patient‐ and radiation oncologist–reported single‐item assessment of depression and anxiety

“…The Akizuki study outlined above was followed up by a screening trial, in which of the 37% of patients identified as being distressed, 93% received a recommendation from their attending physician for a psycho‐oncology service consultation, but only 25% accepted the referral . As such, there is a need to understand oncology patient preferences for being offered, and barriers to accepting, referrals to psychosocial services . This study describes among oncology patients undergoing radiotherapy (RT): the proportion who are likely to be experiencing symptoms of depression or anxiety, as identified by 3 brief measures (a standardised brief assessment tool [HADS]; single items assessing patients' perceptions [ultrashort tool]; and single items assessing judgements of the patient's radiation oncologist); the proportion of patients who would like to be offered professional support for their current levels of depression and anxiety (and reasons for not wanting this); and agreement between the HADS and ( a ) single‐item patient‐reported assessments of their depression and anxiety and ( b ) clinician judgements of anxiety and depression. …”