Abstract Objective Fear of cancer recurrence (FCR) is highly prevalent, however there is no formal training for clinicians to address FCR. A novel brief clinician intervention to help patients manage FCR (Clinician Intervention to Reduce Fear of Recurrence (CIFeR)) was shown to be feasible, acceptable, and reduced FCR in breast cancer patients in a pilot study. We now aim to explore the barriers and facilitators of implementing CIFeR within routine oncology practice in Australia. Methods This multicentre, single‐arm Phase I/II implementation study recruited surgical, medical and radiation oncologists who treat women with early breast cancer. Participating clinicians completed online CIFeR training and were asked to use CIFeR for the next 6 months. Questionnaires were administered before (T0), immediately after (T1), then 3 (T2) and 6 months (T3) after training to assess confidence in addressing FCR and Proctor Implementation outcomes. The primary outcome was adoption at T2. Secondary outcomes were self‐efficacy in FCR management, acceptability, feasibility, costs, barriers and facilitators of implementation. Results Fifty‐two clinicians consented of whom 37 completed the CIFeR intervention training. Median age of participants was 41.5 (range 29–61), 73% were female and 51% were medical oncologists. The primary endpoint was met, with CIFeR adopted by 82%. Clinician intervention delivery took 7.4 min on average and was deemed acceptable, appropriate and feasible. Self‐efficacy in managing FCR improved significantly across all domains ( p < 0.001). Lack of time was the greatest barrier to routine CIFeR_2 implementation. Conclusions A structured brief, low‐cost clinician intervention to reduce FCR is useful, acceptable and improved self‐efficacy with FCR management. Fear of cancer recurrence training should be incorporated into communication skills training of oncologists and surgeons. Trial Registration Prospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001697875. Trial Sponsor Chris O’Brien Lifehouse.
Abstract Background Clinical pathways (CPs) can improve health outcomes, but to be sustainable, must be deemed acceptable and appropriate by staff. A CP for screening and management of anxiety and depression in cancer patients (the ADAPT CP) was implemented in 12 Australian oncology services for 12 months, within a cluster randomised controlled trial of core versus enhanced implementation strategies. This paper compares staff-perceived acceptability and appropriateness of the ADAPT CP across study arms. Methods Multi-disciplinary lead teams at each service tailored, planned, championed and implemented the CP. Staff at participating services, purposively selected for diversity, completed a survey and participated in an interview prior to implementation (T0), and at midpoint (6 months: T1) and end (12 months: T2) of implementation. Interviews were recorded, transcribed and thematically analysed. Results Seven metropolitan and 5 regional services participated. Questionnaires were completed by 106, 58 and 57 staff at T0, T1 and T2 respectively. Eighty-eight staff consented to be interviewed at T0, with 89 and 76 at T1 and T2 (response rates 70%, 66% and 57%, respectively). Acceptability/appropriateness, on the quantitative measure, was high at T0 (mean of 31/35) and remained at that level throughout the study, with no differences between staff from core versus enhanced services. Perceived burden was relatively low (mean of 11/20) with no change over time. Lowest scores and greatest variability pertained to perceived impact on workload, time and cost. Four major themes were identified: 1) Mental health is an important issue which ADAPT addresses; 2) ADAPT helps staff deliver best care, and reduces staff stress; 3) ADAPT is fit for purpose, for both cancer care services and patients; 4) ADAPT: a catalyst for change. Opposing viewpoints are outlined. Conclusions This study demonstrated high staff-perceived acceptability and appropriateness of the ADAPT CP with regards to its focus, evidence-base, utility to staff and patients, and ability to create change. However, concerns remained regarding burden on staff and time commitment. Strategies from a policy and managerial level will likely be required to overcome the latter issues. Trial registration The study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/ .
Abstract Background For people with primary brain tumors (PBT) and their carers, care coordination (CC) offers comprehensive, timely, person-centered care. This review aimed to systematically scope the breadth of literature relevant to approaches to CC for PBT. Methods Four databases were searched (PubMed, PsycINFO, EMBASE, & CINAHL) for empirical research, and grey literature searched for doctoral theses, clinical guidelines, and education resources for healthcare professionals (HCPs) related to the concept/model of CC in neuro-oncology. Data were systematically evaluated and synthesized following PRISMA-SCR guidelines. Results From 1,163 screened abstracts, 30 eligible reports were reviewed (13 addressed CC interventions, 9 narrative reports, 5 describing CC/navigator positions, and 3 clinical guidelines). Most reports described nurse-led models of care within single tertiary care centres in metropolitan settings: a single HCP acting as primary contact, educator, and liaison, screening patient/carer distress and providing referrals as key components of CC. Clinical guidelines emphasise healthcare system navigation and access to medical care in CC. A CC approach overseeing the whole PBT trajectory was lacking. Facilitators of CC included availability of HCP dedicated to CC; HCPs’ competency in relationship-based and communication skills; and improved access to resources. System-level and resource barriers to CC were identified. Conclusions Knowledge about CC is largely based on descriptions of nurse-led models of PBT care. Further research is required to refine the framework of CC reflecting factors of known importance in PBT care, and identify training and support needs of HCPs who may play a pivotal role in current models of neuro-oncology CC.
People living with high-grade glioma (HGG) have diverse and complex needs. Screening aims to detect patients with some level of unmet need requiring triaging and further assessment. However, most existing measures of unmet need are not suitable for screening in this population due to their length. We aimed to explore the clinical utility of a brief screening tool (SCNS-ST9) in people with HGG in detecting unmet needs.Secondary analysis of data collected in a prospective cohort study of 116 people with HGG who completed the Supportive Care Needs Survey (SCNS-SF34) and a brain cancer-specific needs survey (BrTSCNS) during chemoradiation (T1) and 6 months later (T2). The SCNS-ST9 contains a subset of 9 items from the SCNS-SF34. Data analysis determined the number of individuals with unmet needs on the SCNS-SF34 and the BrTSCNS, not identified as having some level of need by the SCNS-ST9.Overall, 3 individuals (T1: 2.6% [3/116]; T2: 4.8% [3/63]) at each time point reported other unmet needs on the SCNS-SF34 that were missed by the SCNS-ST9. Domain-specific screening items missed a higher proportion of individuals (3.2%-26%), particularly in the psychological and health systems domains. Only 1 individual with brain cancer-specific needs was missed by SCNS-ST9 overall.Findings demonstrate the sensitivity and clinical utility of a brief screening tool (SCNS-ST9) of unmet needs in people with HGG. Routine use of this screening tool, supported by clinical pathways, may improve access to support services, potentially reducing the burden of disease for these patients.
Objective - Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. Methods - PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords ‘psychotropic’, ‘antidepressants’, ‘prescription’ and ‘cancer’. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. Results - Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI= 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI= 4.3-12.5), more common in female (22.6%; 95% CI= 16-31) or breast cancer patients (22.6%; 95% CI= 16-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens.
Conclusions - There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the health care providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed.
Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). Of 8 studies identified, none adhered to the definition of 'collaborative care'. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care. The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.
Abstract Objective Fear of cancer recurrence (FCR) is highly prevalent among cancer survivors, but irregularly identified in practice. Single‐item FCR measures suitable for integration into broader psychosocial screening are needed. This study evaluated the validity of a revised version of the original FCR‐1 (FCR‐1r) and screening performance alongside the Edmonton Symptom Assessment System – Revised (ESAS‐r) anxiety item. Methods The FCR‐1r was adapted from the FCR‐1 and modelled on the ESAS‐r. Associations between FCR‐1r and FCR Inventory‐Short Form (FCRI‐SF) scores determined concurrent validity. Relationships of FCR‐1r scores with variables related (e.g., anxiety, intrusive thoughts) and unrelated (e.g., employment/marital status) to FCR determined convergent and divergent validity respectively. A Receiver‐Operating Characteristic analysis examined screening performance and cut‐offs for the FCR‐1r and ESAS‐r anxiety item. Results 107 participants were recruited in two studies (Study 1, July‐October 2021, n = 54; Study 2: November 2021‐May 2022, n = 53). The FCR‐1r demonstrated concurrent validity against the FCRI‐SF ( r = 0.83, p < 0.0001) and convergent validity versus the Generalised Anxiety Disorder‐7 ( r = 0.63, p < 0.0001) and Impact of Event Scale‐Revised Intrusion subscale ( r = 0.55, p < 0.0001). It did not correlate with unrelated variables (e.g., employment/marital status), indicating divergent validity. An FCR‐1r cut‐off ≥5/10 had 95% sensitivity and 77% specificity for detecting clinical FCR (area under the curve (AUC) = 0.91, 95% CI 0.85–0.97, p < 0.0001); ESAS‐r anxiety cut‐off ≥4 had 91% sensitivity and 82% specificity (AUC = 0.87, 95% CI 0.77–0.98, p < 0.0001). Conclusions The FCR‐1r is a valid and accurate tool for FCR screening. Further evaluation of the screening performance of the FCR‐1r versus the ESAS‐r anxiety item in routine care is needed.
In our on-going pilot study of adjustment to severe burns injury in an adult cohort we have had the opportunity to obtain an Adult Attachment Interview (AAI) from some participants. The semi-structured interview was modified from the basic AAI with probes for the setting of severe burns as a trauma and for our interest in the utility of spiritual modes of coping. Some probes were inserted to ascertain whether God or a Higher Power functioned as an attachment figure in the past or during the present situation of recovery from a severe burn. While the study is still in progress and the full data set is not yet available, a number of the interviews suggest that for certain individuals their spiritual relationship with God is central to their current sense of self and their coping strategies. For some their secure state of mind, founded in a sense of lovability and support, rather than a religious identification, fosters a sense of humility and coping. We will present excerpts from AAIs that illustrate the concept of a spiritual relationship functioning as a secure base and the sense of being loved that is associated with an autonomous/secure state of mind. This state of mind appears to be associated with tolerance, forgiveness, humility and an ability for appearance-reality distinctions, often despite difficult early life experiences. This flexibility of mind and its fruit of resilience is predicted by attachment theory. Our early observation is that such a state of mind is associated with good adjustment but we await the completion of data collection and full quantitative and qualitative analysis to fully appraise our hypothesis.
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