ORIGINAL ARTICLE Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process Joanne M Shaw 1 & Melanie A Price 1,2 & Josephine M Clayton 3,4 & Peter Grimison 4,5 & Tim Shaw 4 & Nicole Rankin 6 & Phyllis N Butow 1,2 Received: 9 February 2015 /Accepted: 13 April 2015 # Springer-Verlag Berlin Heidelberg 2015 Abstract Purpose People with cancer and their families experience high levels of psychological morbidity. However, many can- cer services do not routinely screen patients for anxiety and depression, and there are no standardized clinical referral path- ways. This study aimed to establish consensus on elements of a draft clinical pathway tailored to the Australian context. Methods A two-round Delphi study was conducted to gain consensus among Australian oncology and psycho-oncology clinicians about the validity of 39 items that form the basis of a clinical pathway that includes screening, assessment, referral and stepped care management of anxiety and depression in the context of cancer. The expert panel comprised 87 multidisci- plinary clinician members of the Australian Psycho-oncology Co-operative Research Group (PoCoG). Respondents rated their level of agreement with each statement on a 5-point Likert scale. Consensus was defined as >80 % of respondents scoring within 2 points on the Likert scale. Results Consensus was reached for 21 of 39 items, and a further 15 items approached consensus except for specific contextual factors, after two Delphi rounds. Formal screening for anxiety and depression, a stepped care model of manage- ment and recommendations for inclusion of length of treat- ment and time to review were endorsed. Consensus was not reached on items related to roles and responsibilities, particu- larly those not applicable across cancer settings. Conclusions This study identified a core set of evidence- and consensus-based principles considered essential to a stepped care model of care incorporating identification, referral and management of anxiety and depression in adult cancer patients. Keywords Cancer . Oncology . Anxiety . Depression . Clinical pathways . Screening Background A cancer diagnosis impacts on patients’ psychological as well as physical functioning. The point prevalence estimate for any mood disorder in cancer patients is 20.7 %, for anxiety disor- ders is 10.3 %, and for adjustment disorders is 19.4 % [1]. Early detection and treatment of anxiety and depression symp- toms not only reduce patient suffering and the likelihood of developing a major mood disorder but also directly impact on the health service through increased treatment adherence and lower health service utilisation [2]. However, despite being readily treatable and having a strong evidence base for inter- ventions [3–5], anxiety/depression are often undetected and overlooked and their severity underestimated [6] in busy can- cer services. To address under-detection of psychological distress, rou- tine screening of all cancer patients using validated, reliable, * Joanne M Shaw joanne.shaw@sydney.edu.au 1 Psycho-oncology Co-operative Research Group, School of Psychol- ogy, The University of Sydney, Level 6 North, Chris O’Brien Lifehouse (C39Z), Sydney, NSW 2006, Australia 2 Centre for Medical Psychology and Evidence-based Decision-mak- ing, School of Psychology, The University of Sydney, Sydney, NSW, Australia 3 HammondCare Palliative & Supportive Care Service, Greenwich Hospital, Greenwich, NSW, Australia 4 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia 5 The Chris O’Brien Lifehouse, Camperdown, NSW, Australia 6 Sydney Catalyst, The University of Sydney, Sydney, NSW, Australia Support Care Cancer DOI 10.1007/s00520-015-2742-5