Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines.
OBJECTIVE
A clinical pathway for anxiety and depression in adult cancer patients was developed to guide best practice in Australia.


METHODS
The pathway was based on a rapid review of existing guidelines, systematic reviews and meta-analyses, stakeholder interviews, a Delphi process with 87 multidisciplinary stakeholders and input from a multidisciplinary advisory panel.


RESULTS
The pathway recommends formalized routine screening for anxiety and depression in patients with cancer at key points in the patient's journey. The Edmonton Symptom Assessment System or distress thermometer with problem checklist is recommended as brief screening tools, combined with a more detailed tool, such as the Hospital Anxiety and Depression Scale, to identify possible cases. A structured clinical interview will be required to confirm diagnosis. When anxiety or depression is identified, it is recommended that one person in a treating team takes responsibility for coordinating appropriate assessment, referral and follow-up (not necessarily carrying these out themselves). A stepped care model of intervention is proposed, beginning with the least intensive available that is still likely to provide significant health gain. The exact intervention, treatment length and follow-up timelines, as well as professionals involved, are provided as a guide only. Each service should identify their own referral network based on local resources and current service structure, as well as patient preference.


CONCLUSIONS
This clinical pathway will assist cancer services to design their own systems to detect and manage anxiety and depression in their patients, to improve the quality of care.
Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.
Phyllis
P
Butow
Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.
Melanie A
MA
Price
Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.
Joanne M
JM
Shaw
Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
Jane
J
Turner
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.|HammondCare Palliative & Supportive Care Service, Pallister House, Greenwich Hospital, Sydney, NSW, Australia.|Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Josephine M
JM
Clayton
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
Peter
P
Grimison
Sydney Catalyst Translational Cancer Research Centre, Camperdown, NSW, Australia.
Nicole
N
Rankin
Psycho-Oncology Co-operative Research Group (PoCoG), The University of Sydney, Sydney, NSW, Australia.|Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), School of Psychology, The University of Sydney, Sydney, NSW, Australia.|Nepean Cancer Care Centre, Sydney West Cancer Network, Kingswood, UK.
Laura
L
Kirsten
D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy; D001315:Australia; D019091:Critical Pathways; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D006295:Health Resources / Q000706:statistics & numerical data / Q000600:supply & distribution; D006801:Humans; D008297:Male; D008403:Mass Screening; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012720:Severity of Illness Index; D059020:Suicidal Ideation