Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation.

PURPOSE: A Pan-Canadian Practice Guideline on Screening, Assessment, and Care of Psychosocial Distress (Depression, Anxiety) in Adults With Cancer was identified for adaptation. METHODS: American Society of Clinical Oncology (ASCO) has a policy and set of procedures for adapting clinical practice guidelines developed by other organizations. The guideline was reviewed for developmental rigor and content applicability. RESULTS: On the basis of content review of the pan-Canadian guideline, the ASCO panel agreed that, in general, the recommendations were clear, thorough, based on the most relevant scientific evidence, and presented options that will be acceptable to patients. However, for some topics addressed in the pan-Canadian guideline, the ASCO panel formulated a set of adapted recommendations based on local context and practice beliefs of the ad hoc panel members. It is recommended that all patients with cancer be evaluated for symptoms of depression and anxiety at periodic times across the trajectory of care. Assessment should be performed using validated, published measures and procedures. Depending on levels of symptoms and supplementary information, differing treatment pathways are recommended. Failure to identify and treat anxiety and depression increases the risk for poor quality of life and potential disease-related morbidity and mortality. This guideline adaptation is part of a larger survivorship guideline series. CONCLUSION: Although clinicians may not be able to prevent some of the chronic or late medical effects of cancer, they have a vital role in mitigating the negative emotional and behavioral sequelae. Recognizing and treating effectively those who manifest symptoms of anxiety or depression will reduce the human cost of cancer.

Shared decision-making in the US--research & development outpaces delivery.

Researchers interested in shared decision-making in the US have developed a set of tools including decision aids and instruction in counseling, to help patients and physicians fully discuss treatment decisions. Although fundamental research and development continues, these tools are disseminated largely through for-profit and not-for-profit companies to group practices and insurance providers. Data on the number of patients and physicians who have access to decision aids and who have ever used a decision aid are not available, but the number may be small. Policy organisations support the integration of shared decision-making into routine medical care. However, widespread adoption is hindered by lack of evidence for a direct impact on the quality or cost of health care, by limited provider use and lack of patient demand. Future growth requires that people learn about and come to expect that they will discuss treatment options and routinely share making decisions about their care with their care providers--and that their providers welcome and support their patients in doing so.

Consumers of health information and health care: challenging assumptions and defining alternatives.

The end of the 20th century saw a sea of change in the view of individuals in relation to their health and health care. The term "consumer" began to be used to describe myriad new roles and responsibilities for lay people who receive health services and who are often the target of health promotion and disease prevention interventions. This article (1) describes how the term "consumer" is used by various stakeholders in the health care sector; (2) specifies the assumptions that underlie the notion that a "new" kind of health care consumer can (and should) have a significant effect on their own health and on the health care system; (3) challenges the evidence base of these assumptions, noting that many are either unsupported or clearly contradicted by what we know; (4) articulates a set of principles to inform an alternative, more productive, and feasible role for individuals with respect to their health and health care; and (5) identifies the implications of those principles for health promotion and health care professionals in the 21st century.

Health research philanthropy in a time of plenty: a strategic agenda.

Generous public investment in the National Institutes of Health (NIH) provides research foundations with a unique opportunity to more closely connect investments in basic research to a payoff in improved health. Foundations can support efforts to integrate what is known from the biological, behavioral, and social sciences to solve the nation's most pressing health problems. In doing so, they will help to build the scientific capacity to conduct high-quality integrative research in anticipation of a more robust public investment in translating what is known about health into what is done to improve and maintain it.