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Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

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Abstract

Purpose

People with cancer and their families experience high levels of psychological morbidity. However, many cancer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral pathways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context.

Methods

A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisciplinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80 % of respondents scoring within 2 points on the Likert scale.

Results

Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of management and recommendations for inclusion of length of treatment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particularly those not applicable across cancer settings.

Conclusions

This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients.

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Acknowledgments

The authors would like to thank the contribution of all participants and Sydney Catalyst, who provided funding for the study.

Conflict of interest

The authors confirm no conflict of interest to declare

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Authors and Affiliations

  1. Psycho-oncology Co-operative Research Group, School of Psychology, The University of Sydney, Level 6 North, Chris O’Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia

    Joanne M Shaw, Melanie A Price & Phyllis N Butow

  2. Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia

    Melanie A Price & Phyllis N Butow

  3. HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Greenwich, NSW, Australia

    Josephine M Clayton

  4. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Josephine M Clayton, Peter Grimison & Tim Shaw

  5. The Chris O’Brien Lifehouse, Camperdown, NSW, Australia

    Peter Grimison

  6. Sydney Catalyst, The University of Sydney, Sydney, NSW, Australia

    Nicole Rankin

Authors
  1. Joanne M Shaw
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  2. Melanie A Price
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  3. Josephine M Clayton
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  4. Peter Grimison
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  5. Tim Shaw
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  7. Phyllis N Butow
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Corresponding author

Correspondence to Joanne M Shaw.

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Shaw, J.M., Price, M.A., Clayton, J.M. et al. Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process. Support Care Cancer 24, 33–41 (2016). https://doi.org/10.1007/s00520-015-2742-5

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  • DOI: https://doi.org/10.1007/s00520-015-2742-5

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