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To evaluate feasibility and effectiveness of a brief psychosocial intervention delivered by front-line health professionals as part of a planned stepped integrated care model

Clinical sites were randomized to the intervention or control condition. Those randomized to the intervention received a training manual and had a one-day skill development program focusing on supportive-expressive, CNT, and dignity-conserving strategies. At intervention sites, the level of intervention was determined based on distress thermometer (DT) scores and assigned to trained healthcare providers. Patients with HADS scores of 8-21 received the health provider intervention described, and those with HADS scores of 22 or higher were referred for specialist treatment. Patients were contacted and offered up to four individual sessions by telephone or face to face. Weekly supervision was provided by a psychiatrist in a group setting. Patients completed baseline measurements in clinic visits and follow-up measures were provided via reply paid envelope. A phone reminder was done to encourage completion of follow-up measures. Health professionals who delivered the intervention included oncology nurses, physiotherapists, cancer care coordinators, radiation therapists, and an occupational therapist.

• N = 358   
• AGE: Mean = 58.9 years
• MALES: 29.9%  
• FEMALES: 69.1%
• KEY DISEASE CHARACTERISTICS: Varied tumor types–breast and gynecologic were most prevalent. Seventy-six percent had disease progression.  
• OTHER KEY SAMPLE CHARACTERISTICS: Most were married and not working. Formal education level ranged from less than high school to university education. Patients taking antidepressants were excluded.

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: Australia

Cluster, randomized, crossover, multi-site design

• Hospital Anxiety and Depression Scale (HADS)
• FACT-General for quality of life
• EQ 5D-5L
• Demoralization scale
• Unmet needs

There were no significant differences in outcome measures between those patients in the intervention or control conditions. In the intervention condition, 112 were allocated to written resources, 115 to the brief intervention, and 18 were allocated to specialist treatment. There were no differences in outcomes in any of these groups. Providers involved in delivering the intervention reported that it was difficult to provide this along with the other demands in daily practice.

The brief intervention delivered by various front-line healthcare professionals was insufficient to effectively manage depression or anxiety. The amount of skill development provided to the mix of providers involved may have been insufficient.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Measurement/methods not well described
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%
• Other limitations/explanation: The timing of follow-up measurement is unclear. The differences in effectiveness according to the provider used for the intervention may be a question. Some of these disciplines have no basic education in psychosocial intervention as part of professional education. Significant education and training for skill development and ongoing clinical supervision are required.

This study did not demonstrate effectiveness of this stepped program and brief intervention by varied healthcare professionals. Other research has shown that nurse-delivered programs can be effective. Many other disciplines do not have the depth of initial education in psychosocial care and may require much more education and training to develop sufficient skill to provide an effective intervention for anxiety and depression.