Clinical Practice Guidelines for the Psychosocial Care of adults with cancer

National Breast Cancer Centre Adn The National Cancer Control Initiative

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01/01/2003

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• Publié par: sfpsycho-oncologie
• Publié le: 01 janvier 2003
• Nombre de lectures: 22
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: English

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Clinical practice guidelines for the psychosocial care of adults with cancer
Clinical practice guidelines
for the psychosocial care of
adults with cancerClinical practice guidelines for the
psychosocial care of adults with cancer
Prepared by the
National Breast Cancer Centre and the National Cancer Control Initiative
Funded by the Department of Health and Ageing
A National Health Priority Area Initiative
Endorsed April 2003© National Breast Cancer Centre 2003
ISBN Print: 1 74127 000 6 Online: 1 74127 006 5
CIP: 610.73698
This work is copyright.Apart from any use as permitted under the Copyright Act 1968, no part
may be reproduced by any process without prior written permission from National Breast Cancer
Centre. Requests and enquiries concerning reproduction and rights should be addressed to the
Copyright Office, National Breast Cancer Centre, Locked Bag 16, Camperdown NSW 1450,
Australia.Website:www.nbcc.org.au Email: [e-mail]
These guidelines were approved by the National Health and Medical Research Council at its 147th
Session on 10 April 2003, under section 14A of the National Health and Medical Research
Council Act 1992 .Approval for the guidelines by NHMRC is granted for a period not exceeding
five years, at which date the approval expires.The NHMRC expects that all guidelines will be
reviewed no less than once every five years. Readers should check with the National Breast
Cancer Centre for any reviews or updates of these guidelines.
The strategic intent of the NHMRC is to provide leadership and work with other relevant
organisations to improve the health of all Australians by:
• fostering and supporting a high quality and internationally recognised research base;
• providing evidence based advice;
• applying research evidence to health issues thus translating research into better health
practice and outcomes; and
• promoting informed debate on health and medical research, health ethics and related issues.
This document is a general guide to appropriate practice, to be followed subject to
the clinician’s judgement and the patient’s preference in each individual case.
The guidelines are designed to provide information to assist decision-making and
are based on the best evidence available at the time of publication.
This is the first edition of the Clinical practice guidelines for the psychosocial care
of adults with cancer . These guidelines are based on the Psychosocial clinical
practice guidelines: providing information support and counselling for women
with breast cancer , published in 2000 by the National Breast Cancer Centre.
It is planned to review the Clinical practice guidelines for the psychosocial care of
adults with cancerby 2008. For further information regarding the status of this
document, please refer to the NHMRC website: http://www.nhmrc.gov.au
This document was prepared by the National Breast Cancer Centre and the National Cancer
Control Initiative. Funding was provided by the Department of Health and Ageing.
The suggested citation for this document is:
National Breast Cancer Centre and National Cancer Control Initiative. 2003.Clinical practice
guidelines for the psychosocial care of adults with cancer . National Breast Cancer Centre,
Camperdown, NSW.
These guidelines can be downloaded from the National Health and Medical Research Council
website: http://www.nhmrc.gov.au Copies of this document can be ordered through the National
Breast Cancer Centre on their toll free number: 1800 624 973.CONTENTS
List of tables iv
List of figures v
Foreword vii
Executive summary xi
Chapter 1: Introduction and background 1
1.1 The impact of cancer 1
1.2 Development of these guidelines 2
1.3 Structure of these guidelines 5
1.4 Issues affecting health professionals who treat patients with cancer 5
1.5 Summary of evidence 7
Chapter 2: Understanding the challenges of cancer and how people react 11
2.1 Emotional and social issues 14
2.2 Psychological issues 16
2.3 Physical issues 22
2.4 Practical needs and financial issues 30
2.5 Towards the end of life issues 32
2.6 Survival issues 34
Chapter 3: Care to be provided by the treatment team to all patients
with cancer 37
3.1 General interactional skills 38
3.2 Providing information 43
3.2.1 Telling a person they have cancer,a recurrence or metastases 43
Clinical practice guidelines for the psychosocial care of adults with cancer i3.2.2 Discussing prognosis 46
3.2.3 Discussing treatment options: Providing information
and choice 51
3.2.4 Preparing patients for potentially life-threatening
procedures and treatment 63
3.2.5 Preparing patients for progression from curative
to palliative treatment 65
3.2.6 Issue for special consideration: Directing people
to quality cancer information on the Internet 67
3.3 Emotional and social support 68
3.4 Practical and financial support 74
3.5 Ensuring continuity of care 77
3.6 Support towards the end of life 80
3.7 Exploring and responding to specific concerns 85
Chapter 4: Referral for specialised care 101
4.1 Types and benefits of specialised care 101
4.2 Treatment of anxiety and depression 107
4.3 How to make a referral 110
Chapter 5: Issues requiring special consideration 113
5.1 Culture 113
5.2 Age 118
5.3 Geography 119
5.4 Sexual orientation 120
ii Clinical practice guidelines for the psychosocial care of adults with cancerAPPENDICES
A. Clinical practice guidelines for the psychosocial care of adults with
cancer: Steering Group Terms of Reference and Membership 125
B. Persons involved in the development of the Psychosocial clinical
practice guidelines: providing information and support for women
with breast cancer 127
C. Guideline development process 128
D. Incidence of cancers in Australia in 1998 137
E. Resources and contacts for patients and the treatment team 138
F. Financial assistance for travel and accommodation 149
G. Recommendations for strategies to overcome barriers to effective
psychosocial referral 149
H. Services for people from culturally and linguistically diverse
backgrounds 153
I. Services and contacts for people from Aboriginal and Torres Strait
Islander Backgrounds 156
J. Recommended Internet sites 156
References 159
Glossary 205
List of Abbreviations 217
Index 219
Clinical practice guidelines for the psychosocial care of adults with cancer iiiLIST OF TABLES
2 Summary of the major issues by cancer type 12
2.2 Type and prevalence of sexual problems reported by patients
with different types of cancer 18
3 Protocols to support psychosocial care in the treatment unit and
evidence to support their implementation 38
3.1 General interactional skills 42
3.2.1 Recommended steps for telling a person they have cancer, a
recurrence or metastases 45
3.2.2or discussing prognosis with individuals
with cancer 50
3.2.3 Recommended steps for discussing treatment options and
encouraging involvement in decision-making 62
3.2.4 Recommended steps involved in adequately preparing a patient
for a potentially threatening medical procedure 64
3.2.5 Recommended steps for preparing patients for transition to
palliative care 67
3.3A Recommended steps involved in ensuring that all people with
cancer have adequate emotional and social support 70
3.3B Support sources that can improve the emotional well-being of
people with cancer 73
3.5 Recommended steps for establishing continuity of care 79
3.6 Recommended steps involved in providing end of life support 84
3.7A Effective strategies/techniques that can be utilised by treatment
team members to improve the psychological well-being
of patients 90
iv Clinical practice guidelines for the psychosocial care of adults with cancer3.7B Example clinician questions to screen for psychological difficulties 92
3.7C Effective psychological and complementary strategies and
techniques that can be utilised by treatment team members to
reduce the impact of physical symptoms 97
3.7D Factors associated with an increased risk of psychosocial problems 98
3.7E Recommended steps for screening people with cancer for
significant psychological problems 100
4.1A A guide to appropriate referral and specialised interventions for
specific problems 103
4.1B Types of interventions and their impact on patients with cancer 105
4.1C Demonstrated effectiveness of therapies/intervention techniques
for specific psychological problems 107
5.1A Recommended steps involved in dealing with cultural issues 115
5.1Bolved in providing psychosocial
support to Aboriginal and Torres Strait Islander people
with cancer 117
A.D.1 Most frequently occurring cancers in Australia in 1998 137
A.D.2 Most frequently occurring cancers in Australia in 1998 by gender 138
LIST OF FIGURES
1 Diagram describing total care of the patient whose disease is
not responsive to treatment 65
2 Summary of care and referral to psychological care 112
Clinical practice guidelines for the psychosocial care of adults with cancer vFOREWORD
Optimal care of the patient with cancer incorporates effectiv ph e ysical and psychological
care.There are currently several clinical practice guidelines available documenting
evidence-based information and treatment recommendations for the physical care of people