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A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial)

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Abstract

Purpose

A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care.

Methods

Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention.

Results

At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference −1.23, 95 % CI −3.81––1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living.

Conclusion

A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.

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Acknowledgments

We thank participating health professionals and patients at Monash Medical Centre, Melbourne; John Hunter Hospital, Newcastle; Royal Brisbane and Women’s Hospital, Brisbane; and Haematology and Oncology Clinics of Australasia, Brisbane. We thank BaCT at Peter MacCallum Cancer Centre for data management and research personnel including Amy Finlay, Nathalie Darlison, Jane Campbell, Sally Licence, and Kerry Fleming. We especially acknowledge Damien Jolley who developed the methodology for the study. Damien died from melanoma on 15.2.2013, and his colleague Andrew Forbes generously undertook statistical analysis.

Author information

Authors and Affiliations

  1. School of Medicine, University of Queensland and Royal Brisbane and Women’s Hospital, Brisbane, Australia

    Jane Turner & Lisa Mackenzie

  2. Level K, Mental Health Centre, Royal Brisbane and Women’s Hospital, Herston, QLD, 4029, Australia

    Jane Turner

  3. University of Newcastle and John Hunter Hospital, Newcastle, Australia

    Brian Kelly

  4. Monash Medical Centre, Melbourne, Australia

    David Clarke

  5. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia

    Patsy Yates

  6. Cancer Institute New South Wales, Sydney, Australia

    Sanchia Aranda

  7. Peter MacCallum Cancer Centre, Melbourne, Australia

    Sanchia Aranda

  8. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Damien Jolley

  9. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Andrew Forbes

  10. Menzies Health Institute Queensland, Griffith University, Brisbane, Australia

    Suzanne Chambers

  11. ICON Cancer Services, Brisbane, Australia

    Maryanne Hargraves

  12. School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia

    Maryanne Hargraves

Authors
  1. Jane Turner
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  3. David Clarke
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Corresponding author

Correspondence to Jane Turner.

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Conflict of interest

The authors declare that they have no conflict of interest.

Disclosures

None.

Funding

beyondblue: the national depression initiative. (Study ID:631570)

The funding body had no role in the study design, collection, analysis or interpretation of data, or writing of report, or decision to submit for publication. The authors have no financial relationship with the funding source. The authors have full control of all primary data and agree to allow the journal to review data if requested.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

This trial is registered with the Australian and New Zealand Clinical Trials Registry. ANZCTR 1260000448044.

Damien Jolley died prior to completion of the trial.

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Turner, J., Kelly, B., Clarke, D. et al. A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial). Support Care Cancer 25, 17–26 (2017). https://doi.org/10.1007/s00520-016-3382-0

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  • DOI: https://doi.org/10.1007/s00520-016-3382-0

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