Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines.

Abstract

Purpose 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 multi-disciplinary stakeholders and input from a multidisciplinary advisory panel. Results The pathway recommends formalised routine screening for anxiety and depression in patients with cancer at key points in the patient’s journey. The Edmonton Symptom Assessment System (ESAS) or Distress Thermometer (DT) with problem checklist are recommended as brief screening tools, combined with a more detailed tool, such as the Hospital Anxiety and Depression Scale (HADS), to identify possible cases. A structured clinical interview will be required to confirm diagnosis. When anxiety or depression is identified it is recommended one person in a treating team takes responsibility for co-ordinating 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. Discussion 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.