title: Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.shaw@sydney.edu.au.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Shaw
authors.affiliation: 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.|Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Melanie A
authors.initials: MA
authors.lastname: Price
authors.affiliation: HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Greenwich, NSW, Australia.|Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Josephine M
authors.initials: JM
authors.lastname: Clayton
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.|The Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Grimison
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Shaw
authors.affiliation: Sydney Catalyst, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Rankin
authors.affiliation: 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.|Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Phyllis N
authors.initials: PN
authors.lastname: Butow
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001315:Australia; D032921:Consensus; D019091:Critical Pathways; D003697:Delphi Technique; D003863:Depression / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D012106:Research; D011795:Surveys and Questionnaires
keywords: Anxiety; Cancer; Clinical pathways; Depression; Oncology; Screening