Abstract
An audit was carried out of 51 oncology patients referred to a clinical psychology service to identify the characteristics of patients selected for referral and to assess change following psychological intervention. A survey was conducted of an unselected sample of oncology patients representative of the workload of the oncology department from which the referrals came, to determine the prevalence of comparable psychosocial problems among patients who were not referred for help and to assess whether doctors were aware of the problems patients reported. Data were collected using the Hospital Anxiety and Depression (HAD) and Mental Adjustment to Cancer (MAC) scales and a problem checklist devised for this study. Referred patients were significantly more anxious and depressed (P < 0.001) and showed poorer adjustment on MAC scales than the surveyed sample, but 30% of the latter group warranted assessment for anxiety and 23% for depression. The number of psychosocial problems of their severity. Intervention was clinically significant mood disorder irrespective of the specific problems of their severity. Intervention was associated with a significant improvement in distress and problems for referred patients by the time of discharge. Psychosocial problems were often undetected by staff even in referred patients. The checklist is a feasible screening method for potentially remediable problems which are cumulatively a significant contributor to cancer patients' distress.
Highlights
'ICRF Medical Oncology Unit, Western General Hospital, Edinburgh EH4 2XU; 2Head of the Medical Statistics Laboratory, Imperial Cancer Research Fund, Lincoln's Inn Fields, London, UK
A survey was conducted of an unselected sample of oncology patients representative of the workload of the oncology department from which the referrals came, to determine the prevalence of comparable psychosocial problems among patients who were not referred for help and to assess whether doctors were aware of the problems patients reported
Data were collected using the Hospital Anxiety and Depression (HAD) and Mental Adjustment to Cancer (MAC) scales and a problem checklist devised for this study
Summary
Eleven consultants (two medical oncologists, seven radiation oncologists and two haematologists), three senior registrars and three registrars took part in the study Patients in both samples completed the Hospital Anxiety and Depression (HAD) Scale (Zigmond and Snaith, 1983), the Mental Adjustment to Cancer (MAC) Scale (Watson et al, 1988) and a psychosocial problem checkst which had been devised for this sudy. Patients were asked to rate on a four-point scale ('not at all' to 'very much') the extent to which they had recently had concerns or difficulties in each of 16 aspects of their lives as a result of their illness and/or treatment They could indicate if the issue did not apply to them, e.g. coping with children. In outpatient clinics in the survey the doctor completed only a single rating of the presence/absence of any psychosocial problems
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