Abstract
BackgroundHigh levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group. Screening tools can be used to increase case identification, however, screening alone does not necessarily translate into better mental health for the patient. Doctors play a key role in providing basic emotional support and transferring the patients in need of such specific support to mental health professionals. This study investigates whether a stepped care model, combining screening, doctor consultation and professional psycho-oncological service in a structured way, improves the emotional wellbeing of cancer patients.Methods/DesignThis study is a cluster randomized trial with two parallel groups (intervention vs. care as usual), set in an academic hospital. Participants are cancer patients, a total of 1,000 at baseline. The intervention consists of stepped psychosocial care. Step one: screening for distress, step two: feedback of screening results to the doctor in charge of the patient and consultation with the patient, and step three: based on a shared patient-doctor decision, either transferal to the consultation liaison (CL) service or not. The outcome will be emotional well-being half a year after baseline, ascertained with the Hospital Anxiety and Depression Scale. Randomization will be done by the cluster randomization of wards.DiscussionMental health problems not only cause emotional suffering but also direct and indirect costs. This calls for timely and adequate psychosocial support, especially as we know that such support is effective. However, not every cancer patient can and must be treated by a mental health professional. Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible. It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective.Trial registrationClinical Trials Register (Clinicaltrials.gov) identifier: NCT01859429 registration date 17 May 2013.
Highlights
High levels of emotional distress in cancer patients often goes unnoticed in daily clinical routine, resulting in severe undertreatment of mental health problems in this patient group
Allocating limited resources most sensibly and economically is of crucial importance for our healthcare system to ensure the best quality of care to as many patients as possible
It is the hope of the STEPPED CARE trial that this model is both effective and efficient, and that it can be implemented in other hospitals as well, if proven to be effective
Summary
Mental health problems cause emotional suffering and direct and indirect costs related to financial, social and clinical issues [32,33]. A meta-analyses by DiMatteo et al [2] showed that patients suffering from clinical depression tend to fail in their oncological treatment three times more often than others. This calls for timely and adequate psychosocial support, especially as we know that such support is effective [34]. Acquisition of data: HD, SB, ArD, AnD, JE, KP, JüM, JoM, TP, FS, J-US, HW. Revising the manuscript for important intellectual content: SS, HD, SB, ArD, AnD, JE, KP, FL, JüM, JoM, DN, TP, FS, J-US, HW, AK. Final approval of the manuscript to be published: SS, HD, SB, ArD, AnD, JE, KP, FL, JüM, JoM, DN, TP, FS, J-US, HW, AK. FL: Medical Oncologist; Head of the University Cancer Center of Leipzig University Hospital.
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