Department of Health Psychology University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Endocrinology and Metabolic Diseases University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Psychooncology. 2019 Apr;28(4):830-838. doi: 10.1002/pon.5029. Epub 2019 Mar 5.
In line with screening guidelines, cancer survivors were consecutively screened on depressive symptoms (as part of standard care), with those reporting elevated levels of symptoms offered psychological care as part of a trial. Because of the low uptake, no conclusions could be drawn about the interventions' efficacy. Given the trial set-up (following screening guidelines and strict methodological quality criteria), we believe that this observational study reporting the flow of participation, reasons for and characteristics associated with nonparticipation, adds to the debate about the feasibility and efficiency of screening guidelines.
Two thousand six hundred eight medium- to long-term cancer survivors were consecutively screened on depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Those with moderate depressive symptoms (PHQ-9 ≥ 10) were contacted and informed about the trial. Patient flow and reasons for nonparticipation were carefully monitored.
One thousand thirty seven survivors (74.3%) returned the questionnaire, with 147 (7.6%) reporting moderate depressive symptoms. Of this group, 49 survivors (33.3%) were ineligible, including 26 survivors (17.7%) already receiving treatment and another 44 survivors (30.0%) reporting no need for treatment. Only 25 survivors (1.0%) participated in the trial.
Of the approached survivors for screening, only 1% was eligible and interested in receiving psychological care as part of our trial. Four reasons for nonparticipation were: nonresponse to screening, low levels of depressive symptoms, no need, or already receiving care. Our findings question whether to spend the limited resources in psycho-oncological care on following screening guidelines and the efficiency of using consecutive screening for trial recruitment in cancer survivors.
根据筛查指南，对癌症幸存者连续进行抑郁症状筛查（作为标准护理的一部分），对报告有较高抑郁症状水平的患者提供心理护理，作为一项试验的一部分。由于参与率低，无法对干预措施的效果得出结论。鉴于试验设计（遵循筛查指南和严格的方法学质量标准），我们认为，这项报告参与流程、不参与的原因和特征的观察性研究，为关于筛查指南的可行性和效率的辩论增添了内容。
使用患者健康问卷-9（PHQ-9）对 2608 名中至长期癌症幸存者连续进行抑郁症状筛查。对有中度抑郁症状（PHQ-9≥10）的患者进行联系，并告知他们有关试验的情况。仔细监测患者的流动情况和不参与的原因。
1037 名幸存者（74.3%）返回了问卷，其中 147 名（7.6%）报告有中度抑郁症状。在这一组中，有 49 名幸存者（33.3%）不符合条件，包括 26 名幸存者（17.7%）已经接受治疗，另有 44 名幸存者（30.0%）报告不需要治疗。只有 25 名幸存者（1.0%）参加了试验。
在接受筛查的幸存者中，只有 1%符合条件，并愿意接受我们试验中的心理护理。不参与的四个原因是：对筛查无反应、抑郁症状水平低、不需要或已经接受治疗。我们的研究结果质疑是否应该将有限的资源用于心理肿瘤学护理，是否应该遵循筛查指南，以及在癌症幸存者中连续筛查是否可以有效地用于试验招募。
