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Objective: Using a vignette-style DCE in a sample of oncology patients, this study explored: (1) the relative influence of the patient's level of concern about their depression on preferences for care, (2) the relative influence of depression severity according to a mental health checklist on preferred treatment-seeking options, and (3) whether patient age and gender were associated with depression care preference.Methods: A discrete choice experiment (DCE) survey of cancer patients was conducted. Hypothetical vignettes to elicit care preferences were created using two attributes: the cancer patient's level of concern about depression (a little or a great deal) and results of a mental health checklist (not depressed or very depressed). Three response options for care preferences were presented, including a self-directed approach, shared care approach, and clinician-directed referral approach. Participants chose their most and least preferred options.Results: A total of 281 cancer patients completed the survey. There was a significant association between level of concern and the most preferred option. Those with a great deal of concern about depression preferred to receive referral from their clinician more than those with a little concern about depression. Males were significantly more likely to select a self-directed approach as their most preferred option.Conclusions: An oncology patient's level of concern about depression may influence the type of care they want to receive from their cancer doctor for depression. This finding has implications for depression screening in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To describe among radiation oncology patients: (1) the proportion likely to be experiencing symptoms of depression and anxiety as identified by (a) the Hospital Anxiety and Depression Scale (HADS; standardised tool), (b) patient-reported single items (ultrashort tool), and (c) radiation oncologist-reported single items (clinician judgement); (2) preferences for being offered psychological support; and (3) agreement between single-item measures and the HADS.Methods: Adult cancer patients (n = 152; consent rate 58%) receiving radiotherapy completed a touchscreen tablet survey assessing symptoms of anxiety and depression (HADS and a single-item tool) and support preferences. Each participant's treating radiation oncologist completed a survey assessing his or her perception of whether the patient was anxious or depressed.Results: Prevalence estimates for likely depression (6.9-18%) and anxiety (17-33%) overlapped across the 3 measures. Overall, only 9.9% of patients (95% CI, 5.6%-16%) wanted to be offered psychological support. For depression, agreement between the HADS and ultrashort tool was fair (κ = 0.37, P < 0.0001); agreement between the HADS and clinician judgement was slight (κ = 0.14, P < 0.05). For anxiety, agreement between the HADS and clinician judgement was not significantly greater than chance alone (κ = 0.04, P = 0.33), and agreement between the HADS and ultrashort tool was moderate (κ = 0.49, P < 0.0001).Conclusions: These findings highlight the important role that oncology consultations play in interpreting assessment tool results and responding to individual patient's history and preferences for psychological support. [ABSTRACT FROM AUTHOR]

Objective To compare the prevalence of anxiety, depression, and stress among rural and urban support persons of haematological cancer survivors and explore factors associated with having one or more of these outcomes. Methods Haematological cancer survivors were identified via 1 of 5 state-based cancer registries and invited to take part in a survey. Those who agreed were asked to pass on a questionnaire package to their support person. Measures included the Depression, Anxiety, and Stress Scale, Support Persons' Unmet Need Survey, and sociodemographic questions. Results Nine-hundred and eighty-nine (66%) participating survivors had a participating support person. There were no significant differences in the proportion of urban versus rural support persons who reported elevated levels of depression (21% vs 23%), anxiety (16% vs 17%), or stress (16% vs 20%), P > .05. Odds of reporting at least 1 indicator of psychological morbidity increased by 10% to 17% for each additional high or very high unmet need and by 2% for those who had relocated from their usual place of residence for the survivor to receive treatment and was decreased by 5% to 54% for those support persons who reported that they had no chronic health conditions. Conclusions Psychological outcomes for rural and urban support persons are similar. Those who have poor health, have had to relocate, and who have multiple unmet needs are particularly vulnerable to poor psychological outcomes. These factors should be assessed to enable early intervention for those at risk of poor outcomes. [ABSTRACT FROM AUTHOR]

Objective A patient-centred approach to discussing life expectancy with cancer patients is recommended in Western countries. However, this approach to eliciting and meeting patient preferences can be challenging for clinicians. The aims of this study were the following: (i) to examine cancer patients' preferences for life expectancy disclosure; and (ii) to explore agreement between cancer patients' preferences for, and perceived experiences of, life expectancy disclosure. Methods Cancer patients undergoing radiotherapy treatment in metropolitan Australia completed a cross-sectional touchscreen computer survey including optional questions about their life expectancy disclosure preferences and experiences. Results Of the 208 respondents, 178 (86%) indicated that they would prefer their clinician to ask them before discussing life expectancy, and 30 (14%) indicated that they would prefer others (i.e. clinicians, family) to decide whether they were given life expectancy information. Of the 175 respondents who were classified as having a self- determined or other-determined disclosure experience, 105 (60%) reported an experience of life expectancy disclosure that was in accordance with their preferences. Cohen's κ was −0.04 (95% CI, −0.17, 0.08), indicating very poor agreement between patients' preferences for and perceived experiences of life expectancy disclosure ( p = 0.74). Conclusions In light of patient-centred prognosis disclosure guidelines, our findings of a majority preference for, and experience of, a self-determined approach to life expectancy disclosure amongst radiation oncology patients are encouraging. However, poor agreement between preferences and experiences highlights that additional effort from clinicians is required in order to achieve a truly patient-centred approach to life expectancy disclosure. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: The Needs Assessment for Advanced Cancer Patients (NA-ACP) is a 132-item self-report questionnaire designed to assess the seven needs domains of patients with advanced, incurable cancer. This study aimed to evaluate the short derivative form of that questionnaire with advanced lung cancer patients. Methods: Item factor loadings, item test-retest data and response distributions were used to retain or reject items from the original NA-ACP scale. This resulted in 38 items being maintained, preserving the original subscales. The response scale was simplified following feedback from patients. 108 people with advanced lung cancer completed the shortened NA-ALCP along with measures of psychological distress (HADS, DT) and quality of life (EORTC QLQ-C30). A-priori predictions were made for divergent and convergent validity. Results: Internal consistency coefficients were satisfactory for six of seven subscales, range 0.71-0.95. Correlations between NA-ALCP and HADS, DT and EORTC-QLQ-C30 provided support for 11 of the 22 divergent ( r = 0.13-0.27) and convergent predictions ( r = 0.45-0.71). Conclusions: Subscales of the NA-ALCP demonstrated internal reliability consistent with the original scale. Results provided supporting evidence for divergent and convergent validity. This study indicates that the NA-ALCP is psychometrically robust, easily understood and one-quarter the length of the original version. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Meeting the psychological, social and physical needs of people with cancer is a challenge for individual health practitioners, health administrators and health policy makers. However, there is a considerable gap between recommended best-evidence psychosocial and supportive care and actual practice. This paper provides a discussion of the reasons for this gap using the precede-proceed model as a theoretical framework. The model is a useful way of classifying potential barriers to the application of recommended best practice into three categories: predisposing factors which influence motivation to behave in a particular way, enabling factors which facilitate the enactment of the behaviour and reinforcing factors which increase the likelihood that the behaviour will be maintained over time. Ways of addressing these barriers are proposed and discussed. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]