87 research outputs found
The psychosocial approach in cancer care: a small step to realise its importance, one giant leap to implement in practice
No full textPublication added to the doi: 10.1002/pon.447
The psychosocial approach in cancer care: a small step to realise its importance, one giant leap to implement in practice
No full textPublication added to the doi: 10.1002/pon.447
Healthcare professionals' perspectives on the prevalence, barriers and management of psychosocial issues in cancer care: A mixed methods study
No full textThis cross-sectional mixed methods survey explores healthcare professionals' perspective on their management of cancer patients' psychosocial concerns, and barriers to integrate the psychosocial approach in their work. An invitation for participation was sent to 4,965 inpatient and outpatient working professionals, of which 583 responded (12% response rate), and 368 fully completed the survey. The majority of respondents does not use a systematic approach to discuss patients' psychosocial concerns, 37.5% use the general question "How are you?," and 65.0% spontaneously addresses various psychosocial aspects. Most psychosocial topics are "sometimes" or "regularly" discussed. Sexuality and return to work are rarely mentioned. About half of the respondents are convinced that they pay enough attention to the psychosocial well-being of cancer patients: by listening, engaging in a deeper conversation, providing advice and through referral. Mostly, patients are referred to a psychologist, a general practitioner, a social worker, a specialised nurse or a centre for well-being and mental health. The barriers experienced, when providing psychosocial support, can be attributed to the patients, to themselves or other healthcare professionals, and to policy restrictions. These barriers should be addressed in order to enable healthcare professionals to improve the integration of the psychosocial approach in cancer care.sponsorship: We want to acknowledge the following: Jessaziekenhuis, Ziekenhuis Oost-Limburg, Sint-Fransiscus ziekenhuis, Regionaal ziekenhuis Sint-Trudo, Mariaziekenhuis Noord-Limburg, LISTEL, the circuits for GPs, physical therapists and psychologists, CM, Solidariteit voor het Gezin, De Voorzorg, Thuisverpleging Lemmens, Thuisverpleging A tot Z, Familiehulp, ONS, Liberale Mutualiteit, OCMW's, Orthos, CGG group LITP and group DAGG, Flemisch federation of occupational therapy, KLAV and the LMN's. Many thanks go out to Eva Cordery who has reviewed the script and has improved the English language. We also thank LSM for funding. (LSM)status: Publishe
A survey in a multidisciplinary group of healthcare professionals: professionals' point of view on the psychosocial approach in cancer care
No full textA Cochrane review on systematic screening and assessment of cancer patients' psychosocial well-being and care needs
No full textPublication added to the doi: 10.1002/pon.447
A Cochrane review on systematic screening and assessment of cancer patients' psychosocial well-being and care needs
No full textPublication added to the doi: 10.1002/pon.447
Systematic screening and assessment of psychosocial well-being and care needs of people with cancer
No full textBackground : Receiving a diagnosis of cancer and the subsequent related treatments can have a significant impact on an individual's physical and psychosocial well-being. To ensure that cancer care addresses all aspects of well-being, systematic screening for distress and supportive care needs is recommended. Appropriate screening could help support the integration of psychosocial approaches in daily routines in order to achieve holistic cancer care and ensure that the specific care needs of people with cancer are met and that the organisation of such care is optimised.
Objectives : To examine the effectiveness and safety of screening of psychosocial well-being and care needs of people with cancer. To explore the intervention characteristics that contribute to the effectiveness of these screening interventions.
Search methods : We searched five electronic databases in January 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, and CINAHL. We also searched five trial registers and screened the contents of relevant journals, citations, and references to find published and unpublished trials.
Selection criteria : We included randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) that studied the effect of screening interventions addressing the psychosocial well-being and care needs of people with cancer compared to usual care. These screening interventions could involve self-reporting of people with a patient-reported outcome measures (PROMs) or a semi-structured interview with a screening interventionist, and comprise a solitary screening intervention or screening with guided actions. We excluded studies that evaluated screening integrated as an element in more complex interventions (e.g. therapy, coaching, full care pathways, or care programmes).
Data collection and analysis : Two review authors independently extracted the data and assessed methodological quality for each included study using the Cochrane tool for RCTs and the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool for NRCTs. Due to the high level of heterogeneity in the included studies, only three were included in meta-analysis. Results of the remaining 23 studies were analysed narratively.
Main results : We included 26 studies (18 RCTs and 8 NRCTs) with sample sizes of 41 to 1012 participants, involving a total of 7654 adults with cancer. Two studies included only men or women; all other studies included both sexes. For most studies people with breast, lung, head and neck, colorectal, prostate cancer, or several of these diagnoses were included; some studies included people with a broader range of cancer diagnosis. Ten studies focused on a solitary screening intervention, while the remaining 16 studies evaluated a screening intervention combined with guided actions. A broad range of intervention instruments was used, and were described by study authors as a screening of health-related quality of life (HRQoL), distress screening, needs assessment, or assessment of biopsychosocial symptoms or overall well-being. In 13 studies, the screening was a self-reported questionnaire, while in the remaining 13 studies an interventionist conducted the screening by interview or paper-pencil assessment. The interventional screenings in the studies were applied 1 to 12 times, without follow-up or from 4 weeks to 18 months after the first interventional screening. We assessed risk of bias as high for eight RCTs, low for five RCTs, and unclear for the five remaining RCTs. There were further concerns about the NRCTs (1 = critical risk study; 6 = serious risk studies; 1 = risk unclear).
Due to considerable heterogeneity in several intervention and study characteristics, we have reported the results narratively for the majority of the evidence.
In the narrative synthesis of all included studies, we found very low-certainty evidence for the effect of screening on HRQoL (20 studies). Of these studies, eight found beneficial effects of screening for several subdomains of HRQoL, and 10 found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We found very low-certainty evidence for the effect of screening on distress (16 studies). Of these studies, two found beneficial effects of screening, and 14 found no effects of screening. We judged the overall certainty of the evidence for the effect of screening on HRQoL to be very low. We found very low-certainty evidence for the effect of screening on care needs (seven studies). Of these studies, three found beneficial effects of screening for several subdomains of care needs, and two found no effects of screening. One study found adverse effects, and the last study did not report quantitative results. We judged the overall level of evidence for the effect of screening on HRQoL to be very low. None of the studies specifically evaluated or reported adverse effects of screening. However, three studies reported unfavourable effects of screening, including lower QoL, more unmet needs, and lower satisfaction.
Three studies could be included in a meta-analysis. The meta-analysis revealed no beneficial effect of the screening intervention on people with cancer HRQoL (mean difference (MD) 1.65, 95% confidence interval (CI) -4.83 to 8.12, 2 RCTs, 6 months follow-up); distress (MD 0.0, 95% CI -0.36 to 0.36, 1 RCT, 3 months follow-up); or care needs (MD 2.32, 95% CI -7.49 to 12.14, 2 RCTs, 3 months follow-up). However, these studies all evaluated one specific screening intervention (CONNECT) in people with colorectal cancer.
In the studies where some effects could be identified, no recurring relationships were found between intervention characteristics and the effectiveness of screening interventions.
Authors' conclusions : We found low-certainty evidence that does not support the effectiveness of screening of psychosocial well-being and care needs in people with cancer. Studies were heterogeneous in population, intervention, and outcome assessment.
The results of this review suggest a need for more uniformity in outcomes and reporting; for the use of intervention description guidelines; for further improvement of methodological certainty in studies and for combining subjective patient-reported outcomes with objective outcomes
An explorative study on systematic assessment of QOL and care needs with the CARES-SF in the early follow-up of patients with digestive cancer
No full textPURPOSE: Systematic assessment of QOL and care needs was applied in two gastroenterology departments to support "Cancer Care for the Whole Patient." METHODS: Patients with digestive cancer were asked to complete the Cancer Rehabilitation Evaluation System-Short Form (CARES-SF) at the start of treatment and 3 months later. Both times CARES data were processed, and summary reports on the retained insights were sent to the reference nurse for use in further follow-up of the patient. Patients' and reference nurse's experiences with the systematic CARES-assessment were explored with several survey questions and semi-structured interviews, respectively. RESULTS: The mean age of the 51 participants was 63 years (SD11.17), 52.9% was male. With the CARES-SF, a large variety of problems and care needs was detected. Problems most frequently experienced, and most burdensome for QOL are a mix of physical complaints, side effects from treatment, practical, relational, and psychosocial difficulties. Only for a limited number of experienced problems a desire for extra help was expressed. All patients positively evaluate the timing and frequency of the CARES-assessment. The majority believes that this assessment could contribute to the discussion of problems and needs with healthcare professionals, to get more tailored care. Reference nurses experienced the intervention as an opportunity to systematically explore patients' well-being in a comprehensive way, leading to detection and discussion of specific problems or needs in greater depth, and more efficient involvement of different disciplines in care. CONCLUSIONS: Systematic QOL and needs assessment with the CARES-SF in oncology can contribute to more patient-centeredness and efficiency of care.sponsorship: We would like to acknowledge the gastroenterology departments who were willing to work with us for this pilot study. Also we would like to thank Limburg Sterk Merk (LSM) for funding the PhD-project of Bojoura Schouten. (Limburg Sterk Merk (LSM))status: Publishe
Assessment of cancer patients' quality of life and psychosocial care needs. A plea for more integrated and patient-centered care.
No full textSummary
In the report ‘Crossing the quality chasm: a new health system for the 21st century’, the Institute Of Medicine (IOM) suggested that patient-centeredness one of the critical components in the pursuit of high-quality care. The IOM stated that ‘care should be respectful of and responsive to patients’ experiences, values, preferences and needs, and patients’ input on these should guide all clinical decisions’. When confronted with cancer and related treatments, patients and their relatives can experience consequences of physical, psychological, social and practical nature. Due to earlier detection and successful therapeutic approaches more and more patients survive or live longer with cancer, and with the related long-term and late-effects. To adequately address the impact of cancer, cancer care should be comprehensive, integrating the medical and the psychosocial approach during active treatment, as well as in follow-up. The objective of this PhD-project was to contribute to the research on the psychosocial aspects and patient-centeredness in Belgian cancer care. This gave rise to several studies.
First, we conducted a quantitative study with 192 cancer patients to study the psychometric robustness of the Flemish Cancer Rehabilitation Evaluation System (CARES), a questionnaire for the assessment of cancer patients’ quality of life (QOL) and care needs. From the psychometric analyses focused on the items, the subscales and comparisons with other tools, we could conclude that the Flemish CARES is a reliable and valid tool. In other words, it is consistent or stable in its measurement, and it measures what it is supposed to measure, namely QOL and care needs.
In the same period, four focus groups (FG) with 26 (ex-)patients were conducted to explore the relevance and completeness of the content, as well as the acceptability and feasibility of the instrument. The results of these FG supported the cross-cultural content validity and feasibility of the Flemish CARES version. Besides, these FG gave insights in patients’ experiences with cancer care, and the match of the care offer with their care needs. Interpersonal and organizational aspects seem to play an important role in the establishment of the (mis)match between cancer care and cancer patients’ care needs.
In a third study, we recruited a multidisciplinary group of healthcare professionals (HCP) working in the in-hospital and ambulatory care context. In an online survey, their perspective on the approach of psychosocial issues in cancer care was explored. The survey revealed that only half of the participants was satisfied with the support or care they provide when cancer patients suffer from psychosocial problems or care needs. In general psychosocial issues are not systematically addressed. The barriers that need to be addressed according to the HCP are mainly related to education, communication, healthcare policy and organization.
For the Cochrane Review conducted within this project, we searched for studies focusing on the effect of systematic screening and assessment of cancer patients’ psychosocial well-being and care needs. Twenty four studies could be included. The evidence found did not support the overall effectiveness of the screening intervention, neither did it bring clarity on the intervention characteristics that could be determinative in the effectiveness of the intervention.
The last study conducted within this PhD-project was an exploratory pilot study. In two different gastroenterology departments, a systematic CARES-assessment was applied in the care process of 51 patients with a digestive cancer. At the start of treatment, three, six and twelve months later the CARES was used to assess their QOL and care needs, and a summary report was sent to the reference nurse for use in care and follow-up. Both patients and reference nurses had positive experiences with the systematic CARES-assessment in daily routine. The tool provided a broad insight on the well-being and care needs of patients, facilitated patient-HCP communication, and efficient referral.
The findings from this PhD-project are a plea for further efforts in clinical practice and research, focused on patient-centeredness and the biopsychosocial approach of patients’ well-being. In these, there should be an emphasis on the importance of ‘making connections’: connections between cancer patients’ needs and cancer care, connections between involved HCP, connections between care contexts and care phases.Limburg Sterk Merk (LSM
Assessment of cancer patients' quality of life and psychosocial care needs. A plea for more integrated and patient-centered care.
No full textSummary
In the report ‘Crossing the quality chasm: a new health system for the 21st century’, the Institute Of Medicine (IOM) suggested that patient-centeredness one of the critical components in the pursuit of high-quality care. The IOM stated that ‘care should be respectful of and responsive to patients’ experiences, values, preferences and needs, and patients’ input on these should guide all clinical decisions’. When confronted with cancer and related treatments, patients and their relatives can experience consequences of physical, psychological, social and practical nature. Due to earlier detection and successful therapeutic approaches more and more patients survive or live longer with cancer, and with the related long-term and late-effects. To adequately address the impact of cancer, cancer care should be comprehensive, integrating the medical and the psychosocial approach during active treatment, as well as in follow-up. The objective of this PhD-project was to contribute to the research on the psychosocial aspects and patient-centeredness in Belgian cancer care. This gave rise to several studies.
First, we conducted a quantitative study with 192 cancer patients to study the psychometric robustness of the Flemish Cancer Rehabilitation Evaluation System (CARES), a questionnaire for the assessment of cancer patients’ quality of life (QOL) and care needs. From the psychometric analyses focused on the items, the subscales and comparisons with other tools, we could conclude that the Flemish CARES is a reliable and valid tool. In other words, it is consistent or stable in its measurement, and it measures what it is supposed to measure, namely QOL and care needs.
In the same period, four focus groups (FG) with 26 (ex-)patients were conducted to explore the relevance and completeness of the content, as well as the acceptability and feasibility of the instrument. The results of these FG supported the cross-cultural content validity and feasibility of the Flemish CARES version. Besides, these FG gave insights in patients’ experiences with cancer care, and the match of the care offer with their care needs. Interpersonal and organizational aspects seem to play an important role in the establishment of the (mis)match between cancer care and cancer patients’ care needs.
In a third study, we recruited a multidisciplinary group of healthcare professionals (HCP) working in the in-hospital and ambulatory care context. In an online survey, their perspective on the approach of psychosocial issues in cancer care was explored. The survey revealed that only half of the participants was satisfied with the support or care they provide when cancer patients suffer from psychosocial problems or care needs. In general psychosocial issues are not systematically addressed. The barriers that need to be addressed according to the HCP are mainly related to education, communication, healthcare policy and organization.
For the Cochrane Review conducted within this project, we searched for studies focusing on the effect of systematic screening and assessment of cancer patients’ psychosocial well-being and care needs. Twenty four studies could be included. The evidence found did not support the overall effectiveness of the screening intervention, neither did it bring clarity on the intervention characteristics that could be determinative in the effectiveness of the intervention.
The last study conducted within this PhD-project was an exploratory pilot study. In two different gastroenterology departments, a systematic CARES-assessment was applied in the care process of 51 patients with a digestive cancer. At the start of treatment, three, six and twelve months later the CARES was used to assess their QOL and care needs, and a summary report was sent to the reference nurse for use in care and follow-up. Both patients and reference nurses had positive experiences with the systematic CARES-assessment in daily routine. The tool provided a broad insight on the well-being and care needs of patients, facilitated patient-HCP communication, and efficient referral.
The findings from this PhD-project are a plea for further efforts in clinical practice and research, focused on patient-centeredness and the biopsychosocial approach of patients’ well-being. In these, there should be an emphasis on the importance of ‘making connections’: connections between cancer patients’ needs and cancer care, connections between involved HCP, connections between care contexts and care phases.Limburg Sterk Merk (LSM
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