Tailored Information

To investigate if providing tailored information to patients with advanced head and neck cancer decreases patients' symptoms of anxiety and depression

Patients at one study site received the intervention, and patients at another study site did not receive the intervention and were treated as a control group. The tailored information used was a multimedia tool that included a patient booklet; interactive computer software; computer animation describing cancer spread, staging, and surgical procedures; and a take-home DVD. The purpose of the packet was to educate patients about diagnostic and adjuvant procedures, nutrition, and speech and swallowing practice. Another component was a database. The database could receive and store patient input and could print information that could be given to the patient. The intervention was provided at the hospital by a nurse who was available to address patients' questions and concerns. The control intervention was usual care provided by a nurse practitioner who provided verbal information and pamphlets and met with some patients in an ad hoc manner. Data were collected at baseline. Outcomes were assessed at three months and six months.

• The study reported on a sample of 96 patients.
• Mean patient age was 59.8 years. The age range was 19–87 years.
• The sample was 75% male and 25% female.
• All patients had stage III or IV primary or recurrent head and neck cancer.
• Most patients received combination radiation and chemotherapy.
• The education level of the groups varied significantly, with patients in the control group having a much higher level of education.
• About half of the sample was employed.

• Multisite 
• Setting not specified
• Montréal, Canada

Active antitumor treatment

Nonrandomized controlled trial

• Distress Thermometer
• Hospital Anxiety and Depression Scale (HADS)

Over time, anxiety was lower in the intervention group (p = 0.001), and there was a significant group-by-time effect (p = 0.025). Anxiety did not decline in the control group over time. Over time, depression declined in both groups (p = 0.001), and there were no group differences in depression. Findings were grouped by low, borderline, and high anxiety levels according to HADS results. In the low-anxiety group, patients reported lower levels of anxiety over time than did controls (p = 0.003). In the borderline group, there were no significant differences between study groups. Among those who had clinical levels of anxiety at baseline, patients had lower levels of anxiety at three months (p = 0.014) and six months (p = 0.005). Among those with clinical depression in the control group, depression initially increased at three months and then decreased toward baseline,

Findings demonstrate that the providing information can have an effect on anxiety. It cannot be determined if the nature of the multimodal intervention was a critical factor or whether providing information in any form would be helpful, since there was no random patient assignment and patients in the control group received information in an inconsistent, ad hoc manner.

• The study had a small sample size, with fewer than 100 participants.
• The study had baseline sample and group differences of import.
• The study had a risk of bias due to no control group, no blinding, no random assignment, and no appropriate attentional control condition.
• Baseline data were obtained after the intervention was given.

Findings suggest that providing information to patients may help reduce patients' anxiety but not their symptoms of depression. This study used a package of information; such a package may be a practical means of ensuring that the information patients receive is consistent. Multiple limitations in this study prevent the drawing of firm conclusions about the effectiveness of the method studied.

To evaluate the effects of a tailored information package for patients with rectal cancer on levels of satisfaction with information, anxiety, depression, and readjustment to normal living

This study was conducted at six sites in four healthcare systems in Northern Ireland. A process evaluation of usual standards-of-care established that all patients with rectal cancer were referred to a stoma nurse specialist following diagnosis. A tailored information packet of 14 leaflets dealing with various aspects of disease and treatment was developed based on the theoretical framework of andragogy, developed by Malcolm Knowles, along with a preliminary needs assessment and a literature review. Preparation for the study involved a liaison between stoma-care nurse specialists to determine interest in participation. The researchers then met with the stoma nurse specialists to discuss the study protocol and provide consistent training regarding the use of the information packet. Data were collected using a researcher-administered set of scales at three time points in structured interviews. These were preintervention, postintervention, after surgery, prior to hospital discharge, and six months after surgery.

• N = 43 (intervention group), 33 (control group)  
• AGE RANGE = 42–76+ years
• MALES: 64.5%, FEMALES: 35.5%
• KEY DISEASE CHARACTERISTICS: Sixty-eight out of 76 patients were considered a B or C in Duke’s staging system. The majority of patients (40) had low anterior resections with loop ileostomies, and 27 patients had abdominoperineal resections (permanent colostomies).
• OTHER KEY SAMPLE CHARACTERISTICS: Thirty-two patients received short-course radiation prior to surgery. Ten of these patients also had adjuvant chemotherapy. Nine patients had long-course preoperative chemotherapy/radiation, and nine patients had adjuvant chemotherapy only.

• SITE: Multi-site    
• SETTING TYPE: Multiple settings  
• LOCATION: Northern Ireland

• PHASE OF CARE: Multiple phases of care
• APPLICATIONS: Elder care, palliative care 

Randomized, controlled trial

The Patient Satisfaction with Cancer Treatment Education (PSCaTE) questionnaire was used. It consists of 14 items. Each item has a scale from 1 (strongly disagree) to 5 (strongly agree). The Hospital Anxiety and Depression Scale (HADS), which contains seven intermingled items answered on a four-point scale, and the Reintegration to Normal Living Index (RNLI), which consists of 11 items on scales of 1–10, also were used. Data analysis was carried out using SPSS software.

There was a statistically significant difference in levels of satisfaction with information between the intervention and control groups. Patients who received the tailored information packet were more satisfied with their information than the control group. There were no differences in depression scores between the intervention and control groups at any time. Females were shown to have significantly higher anxiety and depression scores at the preintervention assessment. All participants with high depression scores also had elevated anxiety scores. Anxiety and depression scores showed medium to large negative associations with adjustment levels as measured by the RNLI scores at all three time points.

Patients who received the tailored information packets were significantly more satisfied than those in the control group at the second and third time points.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Other limitations/explanation: This study only assessed satisfaction up to six months following surgery. Caregivers were not included in the study. This study focused predominantly on paper-based literature as an intervention. The Pearson coefficient was used in the analysis to assess for satisfaction; although this is appropriate, it is not as robust in terms of statistical significance.