Chan, R.J., Webster, J., & Marquart, L. (2011). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273.

To assess effects of interventions that orient patients and carers to a cancer care facility and to the services provided

• Databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO. Investigators also searched reference lists and abstracts from relevant proceedings. Specific journals were searched separately.
• Authors provide an extensive listing of search terms and specific search language for each database. In addition to all relevant terms for cancer, key terms included patient education, patient information, mass communications, audio, video, cassette, tape, dvd, compact disc, media, multi media, internet, website, pamphlet, booklet, and phone or print material.
• Studies were included in the review if they were randomized controlled trials (RCTs) and quasi-RCTs that compared the effect that orientation achieved in an intervention group with the effect achieved in a control group or compared one orientation intervention with another orientation intervention.

Initial searching identified 14,319 records. Investigators assessed 21 full-text articles for eligibility, and the systemaic review included a sample of four. Two studies were included in meta-analysis. Study quality was assessed using guidelines in the Cochrane Handbook for Systematic Reviews of Interventions.

• The final sample of four studies involved 631 patients.
• Sample sizes were 31–304 and included new patients, over 18 years of age, with cancer.
• All studies allowed family and carers to receive the intervention along with the patient.
• Various diagnoses were represented.

• Studies were generally of low to very low overall quality.
• Components of the oreitnation programs were information about the healthcare team, a clinic tour, information about the facility (parking, hours of operation, etc.), description of clinical procedures, information about supportive services available, treatment-related information, and question-and-answer sessions.
• Formats used were written materials in all studies and videotape in one study. Interventions were delivered via mail or face-to-face. Timing of orientation varied. Intervention intensity could only be measured by length of time taken for reading or watching a video or duration of face-to-face interactions.

Effects of Interventions

• Knowledge and understanding: Two studies reported better knowledge and understanding with the intervention or risks, benefits, and side effects of treatment. Pooled analysis of these results gave a mean difference (MD) of –0.18, 95% CI –1.02 through 0.66.
• State anxiety: Two trials measured effect on state anxiety. Pooled analysis showed MD of –9.77, 95% CI –24.96 through 5.41. In one of these trials, there was a significant difference in trait anxiety between study groups at baseline.
• General anxiety: One trial measured general anxiety by using the Brief Symptom Inventory and found no differences between groups.
• Mood disturbance: Two trials evaluated general distress. Analysis showed significant difference in favor of the intervention group (MD = –8.96, 95% CI –11.79 through –6.13).
• Symptoms of depression: Three studies reported positive benefits of the intervention on symptoms of depression. Postintervention meta-analysis showed no difference in depression scores (MD = –0.4, 95% CI –2.95 through –2.15).

This review shows that orientation programs may reduce distress in patients with cancer at the beginning of their involvement with a cancer care facility, but the quality of the evidence is low. Orientation programs may have some effect on general distress and symptoms of depression; however, findings do not show significant effects on anxiety.

These findings are limited by the small number of trials included, low quality of studies, and high heterogeneity found related to some outcomes.

Orientation of the patient, the patient's family, and those who care for the patient may help to reduce a patient's symptoms of depression and level of distress; however, this study does not reveal strong support for these outcomes. The most effective format and timing of orientation approaches are unclear.