Information interventions for orienting patients and their carers to cancer care facilities

Raymond J Chan; Joan Webster; Louise Marquart

doi:10.1002/14651858.CD008273.pub2

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Figure 1

Study flow diagram.

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 4

Analysis 2.1: Interventions to reduce anxiety compared with control, State anxiety (STAI‐S)

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Figure 5

Analysis 3.1: Interventions to reduce distress compared with control, Profile of Mood State ‐ Total Mood Disturbance (POMS‐TMD)

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Analysis 1.1

Comparison 1 Interventions to increase knowledge compared with control, Outcome 1 Radiation knowledge.

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Analysis 2.1

Comparison 2 Interventions to reduce anxiety compared with control, Outcome 1 State Anxiety (STAI‐S).

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Analysis 2.2

Comparison 2 Interventions to reduce anxiety compared with control, Outcome 2 Trait Anxiety (STAI‐T).

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Analysis 2.3

Comparison 2 Interventions to reduce anxiety compared with control, Outcome 3 Brief Symptom Inventory (BSI) ‐ Anxiety.

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Analysis 3.1

Comparison 3 Interventions to reduce distress compared with control, Outcome 1 Profile of Mood State ‐ Total Mood Disturbance.

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Analysis 3.2

Comparison 3 Interventions to reduce distress compared with control, Outcome 2 Emotional distress (General Severity Index).

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Analysis 4.1

Comparison 4 Interventions to reduce depression compared with control, Outcome 1 Brief Symptom Inventory (BSI) ‐ Depression.

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Summary of findings for the main comparison. Information interventions for orientation to cancer care facilities for

Information interventions for orientation to cancer care facilities for patients and carers
Patient or population: patients and carers Settings: cancer care centres Intervention: Information interventions for orientation to cancer care facilities
Outcomes	Effects of Information interventions for orientation to cancer care facilities	No of Participants (studies)	Quality of the evidence (GRADE)
Knowledge and understanding of cancer/treatment Patients and relatives	One study found that patient reported knowledge of cancer/ chemotherapy was significantly better following an orientation program. Another study found non significant reduction in the knowledge of radiation therapy scores of patients and relatives following an orientation program.	156 (2 studies)	⊕⊝⊝⊝ very low^1,2
Trait anxiety STAI (T). Scale from: 0 to 60. Patients	The mean trait anxiety in the intervention groups was 4.7 lower (8.37 to 1.03 lower)	110 (1 study)	⊕⊕⊝⊝ low^1,3
State anxiety STAI‐S. Scale from: 0 to 60. Patients	The mean state anxiety in the intervention groups was 9.77 lower (24.96 lower to 5.41 higher)	188 (2 studies)	⊕⊕⊝⊝ low^1,4
Distress POMS‐TMDS (unclear range of scores) Patients	The mean distress in the intervention groups was 8.96 lower (11.79 to 6.13 lower)	188 (2 studies)	⊕⊕⊝⊝ low⁵
Depression BSI Patients	In one study, the mean depression in the intervention groups was 0.4 lower (2.95 lower to 2.15 higher). Two other studies reported positive benefits in depressive symptoms which were significant.	304 (3 studies)	⊕⊕⊝⊝ low^1,3
Satisfaction by patients and relatives	Patients reported significant improvement in satisfaction, however for relatives there was no significant effect.	85 (1 study)	⊕⊕⊝⊝ low^1,2
Harms or adverse events ‐ not reported	No studies measured harms and no studies reported adverse events.	‐	‐
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Few participants. ² Allocation concealment was unclear, blinding of intervention not possible and of outcome assessment unclear, and the numbers of participants analysed were not reported. ³ Blinding of intervention not possible in study. ⁴ There was high heterogeneity (I² = 92%). The heterogeneity might be due to the different assessment time points and the different treatments these newly registered patients were about to receive (chemotherapy vs. radiation therapy) ⁵ Both trials had relatively few patients. There were also potential skewness in data as reported by trial authors, particularly in the Hoff 2005 trial.

Summary of findings for the main comparison. Information interventions for orientation to cancer care facilities for

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Table 1. Components, modes and delivery methods of orientation interventions in the included studies

Study

Components

Mode

Delivery method

Information of healthcare team

(e.g. roles, contact numbers)

Clinic tour

Information of the facility (e.g. map, parking, opening hours)

Description of clinical procedures

Information of supportive services

Resources available after treatment

Question and answer session

Treatment related information (e.g. coping strategies, understanding chemotherapy/ radiotherapy)

Audiovisual

Written materials

Mail

Face to face

√

√

√

√

A tick in the appropriate boxes represents the components, modes and delivery methods used.

Table 1. Components, modes and delivery methods of orientation interventions in the included studies

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Comparison 1. Interventions to increase knowledge compared with control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Radiation knowledge Show forest plot	1	51	Mean Difference (IV, Fixed, 95% CI)	‐0.18 [‐1.02, 0.66]

Comparison 1. Interventions to increase knowledge compared with control

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Comparison 2. Interventions to reduce anxiety compared with control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 State Anxiety (STAI‐S) Show forest plot	2	188	Mean Difference (IV, Random, 95% CI)	‐9.77 [‐24.96, 5.41]

2 Trait Anxiety (STAI‐T) Show forest plot	1	110	Mean Difference (IV, Fixed, 95% CI)	‐4.70 [‐8.37, ‐1.03]

3 Brief Symptom Inventory (BSI) ‐ Anxiety Show forest plot	1	204	Mean Difference (IV, Fixed, 95% CI)	‐0.20 [‐3.07, 2.67]

Comparison 2. Interventions to reduce anxiety compared with control

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Comparison 3. Interventions to reduce distress compared with control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Profile of Mood State ‐ Total Mood Disturbance Show forest plot	2	188	Mean Difference (IV, Fixed, 95% CI)	‐8.96 [‐11.79, ‐6.13]

2 Emotional distress (General Severity Index) Show forest plot	1	204	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐2.34, 2.74]

Comparison 3. Interventions to reduce distress compared with control

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Comparison 4. Interventions to reduce depression compared with control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Brief Symptom Inventory (BSI) ‐ Depression Show forest plot	1	200	Mean Difference (IV, Fixed, 95% CI)	‐0.40 [‐2.95, 2.15]

Comparison 4. Interventions to reduce depression compared with control

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