title: Interventions to improve screening and appropriate referral of patients with cancer for distress: systematic review protocol.
abstract: BACKGROUND
  It is estimated that 35-40% of patients with cancer experience distress at some stage during their illness. Distress may affect functioning, capacity to cope, treatment compliance, quality of life and survival of patients with cancer. Best practice clinical guidelines recommend routine psychosocial distress screening and referral for further assessment and/or psychosocial support for patients with cancer. However, evidence suggests this care is not provided consistently.
  
  
  METHODS
  We developed our methods following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The review is registered with PROSPERO and any amendments to the protocol will be tracked. The primary aim of this systematic review is to examine the impact of interventions delivered in healthcare settings that are aimed at (1) improving routine screening of patients for psychosocial distress and (2) referral of distressed patients with cancer for further assessment and/or psychosocial support. The effectiveness of such interventions in reducing psychosocial distress, and any unintended adverse effect of the intervention will also be assessed in patients with cancer. Data sources will include the bibliographic databases Cochrane Central Register of Controlled trials (CENTRAL) in the Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. Eligible studies must compare an intervention (or two or more interventions) in a healthcare setting to improve the rate of screening for psychosocial distress and/or referral for further assessment and/or psychosocial support for patients with cancer with no intervention or 'usual' practice. Two investigators will independently review titles and abstracts, followed by full article reviews and data extraction. Disagreements will be resolved by consensus and if necessary, a third reviewer. Where studies are sufficiently homogenous, trial data will be pooled and meta-analyses performed.
  
  
  BACKGROUND
  No ethical issues are foreseen. The findings of this study will be disseminated widely via peer-reviewed publications and conference presentations.
  
  
  BACKGROUND
  PROSPERO registration number CRD4 2015017518.
authors.affiliation: School of Psychology, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Kristen
authors.initials: K
authors.lastname: McCarter
authors.affiliation: Faculty of Health and Medicine, Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Britton
authors.affiliation: Faculty of Health and Medicine, Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Baker
authors.affiliation: School of Psychology, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Halpin
authors.affiliation: Faculty of Health and Medicine, Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Beck
authors.affiliation: Faculty of Health and Medicine, Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.affiliation: Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, New South Wales, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Wratten
authors.affiliation: Centre for Dietetics Research, The University of Queensland, St Lucia, Queensland, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Bauer
authors.affiliation: University Library, University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Debbie
authors.initials: D
authors.lastname: Booth
authors.affiliation: Faculty of Health and Medicine, Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Erin
authors.initials: E
authors.lastname: Forbes
authors.affiliation: School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
authors.forename: Luke
authors.identifier: http://orcid.org/0000-0002-6178-3868
authors.initials: L
authors.lastname: Wolfenden
mesh_terms: D055317:Evidence-Based Practice; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D017410:Practice Guidelines as Topic; D016730:Program Development; D011788:Quality of Life / Q000523:psychology*; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D000078202:Systematic Reviews as Topic