title: A tiered multidisciplinary approach to the psychosocial care of adult cancer patients integrated into routine care: the PROMPT study (a cluster-randomised controlled trial).
abstract: A stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care.
  
  
  
  Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention.
  
  
  
  At 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference -1.23, 95 % CI -3.81--1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living.
  
  
  
  A brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.
authors.affiliation: School of Medicine, University of Queensland and Royal Brisbane and Women's Hospital, Brisbane, Australia. jane.turner@uq.edu.au.|Level K, Mental Health Centre, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia. jane.turner@uq.edu.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Turner
authors.affiliation: University of Newcastle and John Hunter Hospital, Newcastle, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Kelly
authors.affiliation: Monash Medical Centre, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Clarke
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
authors.forename: Patsy
authors.initials: P
authors.lastname: Yates
authors.affiliation: Cancer Institute New South Wales, Sydney, Australia.|Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Sanchia
authors.initials: S
authors.lastname: Aranda
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Forbes
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Chambers
authors.affiliation: ICON Cancer Services, Brisbane, Australia.|School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia.
authors.forename: Maryanne
authors.initials: M
authors.lastname: Hargraves
authors.affiliation: School of Medicine, University of Queensland and Royal Brisbane and Women's Hospital, Brisbane, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Mackenzie
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*
keywords: Cancer; Depression; Distress; Psychosocial; Training; Treatment