Using the theory of planned behavior to understand health professionals' attitudes and intentions to refer cancer patients for psychosocial support.

OBJECTIVE: To describe oncology professionals' patterns of referral to existing community and psychosocial support services, including complementary therapies utilizing the theory of planned behavior (TPB). METHODS: An exploratory cross-sectional survey of 72 oncology professionals including nurses (73.6%), medical practitioners (19.4%) and allied health professionals (6.9%) from health institutions in South Australia assessed past referral patterns, perceived attitudes of peers, control over and attitudes toward, referral, past referral practices and how these impact on intention to refer. RESULTS: Referral to support services such as a cancer helpline, allied health or complementary services was infrequent. A hierarchical regression entering awareness, past referral and the TPB variables (attitude, subjective norm and perceived control) explained 51% of the variance on the outcome 'intention to refer'. Barriers to referral for support included lack of local services for remote patients, and financial considerations. CONCLUSION: Interventions with health professionals should focus on the development of a culture, which recognizes the importance of addressing a breadth of patient needs across the cancer trajectory. Education and support for health professionals is required to ensure that they feel comfortable discussing support needs and referring to appropriate support services.

Mindfulness-based cognitive therapy: an efficacious community-based group intervention for depression and anxiety in a sample of cancer patients.

OBJECTIVE: To assess the impact of an 8-week structured mindfulness-based cognitive therapy (MBCT) program on individuals experiencing distress as a consequence of cancer. DESIGN, SETTING AND PARTICIPANTS: Prospective study of 16 participants with a history of cancer and five carers of people with cancer recruited from August 2008 to February 2009 through calls to the Cancer Council South Australia Helpline. Participants were assessed for anxiety and depression before and after undergoing a course in MBCT between 30 September and 18 November 2008 and 20 February and 10 April 2009. MAIN OUTCOME MEASURES: Depression, anxiety and mindfulness as measured by the Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory (STAI), and Freiburg Mindfulness Inventory (FMI), respectively, and a consumer-centred evaluation. RESULTS: There were significant reductions in depression (F[1,24] = 6.37; P = 0.012; partial-eta2 = 0.27) and anxiety (F[2,34] = 9.43; P = 0.001, partial-eta2 = 0.36) and mindfulness (F[2,32] = 8.36; P = 0.001; partial-eta2 = 0.34) following the intervention, and these effects were sustained at the 3-month follow-up. Reliable change indices further support these findings. Participants' scores on measures of depression and anxiety decreased as a function of increased mindfulness, as reflected by significant (P < 0.05) negative correlations between FMI scores and BDI-II scores (ranging from r = -0.46 to r = -0.79) and STAI scores (ranging from r = -0.46 to r = -0.50) scores at all time points. CONCLUSION: The MBCT program appears to be an efficacious intervention for use among people affected by cancer who also experience symptoms of depression and anxiety.