COSA 2014* Uptake and adherence to psychological support for cancer patients: A meta-regression (#130)
Aims
Although guidelines recommend screening for distress amongst cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake of and adherence to individual psychological support and to identify predictors of each.
Methods
Searches were conducted in Embase, Medline, PsychInfo and Scopus to identify studies reporting uptake or adherence rates for individual psychological support offered to cancer patients or survivors.
Results
Across the 52 included studies reporting rates for 11,871 patients and survivors, the weighted uptake and adherence rates were 59.2% and 90.1%, respectively. Rates of uptake were expected to be higher for patients who had been screened and identified as distressed compared to unscreened patients, but this was not the case, with results trending in the opposite direction. Studies selecting patients with higher distress reported a lower uptake rate (51.0%) than those not (65.5%), but this difference was not statistically significant (Q(1)=3.80, p=0.051, 95% CI -0.003 - 1.242). Neither the type of therapy nor the minimum number of sessions offered was associated with uptake or adherence (Q(1)<2.14, p=> 0.143, 95%CI -0.151 - 0.219). Uptake of therapy was greater for interventions delivered by telephone (71.2%) rather than face-to-face (55.3%) (Q(1)=4.22, p=0.040 95%CI 0.0318-1.3688) and when therapy was offered prior to medical treatment (72.9%) compared to later (55.5%) (Q(1)=4.28, p=0.0385, 95%CI 0.041 - 1.499). Patients were more likely to accept psychological support from nurses (67.6%) than other allied health professionals (45.4%) (Q(1)=9.09, p=0.003, 95% CI -1.543 - -0.373).
Conclusions
Rates of acceptance of psychological support were low, but adherence was high. Patients appeared more receptive to interventions offered near diagnosis, over the telephone and by nurses. Research is needed to understand barriers to acceptance of psychological support, particularly since uptake rates were not higher for distressed patients.
Although guidelines recommend screening for distress amongst cancer patients and offering psychological support when indicated, many patients decline offers of such support. This study aimed to quantify uptake of and adherence to individual psychological support and to identify predictors of each.
Methods
Searches were conducted in Embase, Medline, PsychInfo and Scopus to identify studies reporting uptake or adherence rates for individual psychological support offered to cancer patients or survivors.
Results
Across the 52 included studies reporting rates for 11,871 patients and survivors, the weighted uptake and adherence rates were 59.2% and 90.1%, respectively. Rates of uptake were expected to be higher for patients who had been screened and identified as distressed compared to unscreened patients, but this was not the case, with results trending in the opposite direction. Studies selecting patients with higher distress reported a lower uptake rate (51.0%) than those not (65.5%), but this difference was not statistically significant (Q(1)=3.80, p=0.051, 95% CI -0.003 - 1.242). Neither the type of therapy nor the minimum number of sessions offered was associated with uptake or adherence (Q(1)<2.14, p=> 0.143, 95%CI -0.151 - 0.219). Uptake of therapy was greater for interventions delivered by telephone (71.2%) rather than face-to-face (55.3%) (Q(1)=4.22, p=0.040 95%CI 0.0318-1.3688) and when therapy was offered prior to medical treatment (72.9%) compared to later (55.5%) (Q(1)=4.28, p=0.0385, 95%CI 0.041 - 1.499). Patients were more likely to accept psychological support from nurses (67.6%) than other allied health professionals (45.4%) (Q(1)=9.09, p=0.003, 95% CI -1.543 - -0.373).
Conclusions
Rates of acceptance of psychological support were low, but adherence was high. Patients appeared more receptive to interventions offered near diagnosis, over the telephone and by nurses. Research is needed to understand barriers to acceptance of psychological support, particularly since uptake rates were not higher for distressed patients.