Intervention Does routine psychosocial screening improve referral to psychosocial care providers and patient–radiotherapist communication? A cluster randomized controlled trial § Anna P.B.M. Braeken a,b,e, *, Lilian Lechner b , Danie ¨lle B.P. Eekers a,c , Ruud M.A. Houben a , Francis C.J.M. van Gils a , Ton Ambergen d , Gertrudis I.J.M. Kempen e a Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands b Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands c Institute Verbeeten, Department of Radiation Oncology, Tilburg, The Netherlands d Department of Methodology & Statistics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands e Department of Health Services Research, CAPHRI School for Public Health and Primary, Maastricht University, Maastricht, The Netherlands 1. Introduction About 30% of cancer patients experience psychosocial distress [1–3], the sixth vital sign [4], and is most frequently characterized by anxiety and depression [5,6]. Radiotherapy (RT) is an effective but invasive treatment for malignant tumors. Patients receiving RT are likely to experience additional stressors such as fear about the radiation treatment devices and side effects (e.g. radiation skin damage) [7,8]. The detection of psychosocial problems is important because treatment at an early stage may improve quality of life [9–12] and minimize the likelihood of developing psychological disorders as for example major depression [12,13]. However, psychosocial distress often remains unrecognized by physicians partly because of low awareness of the existence of psychosocial problems and time pressure [8,14]. Thereby, physi- cians primarily focus on physical symptoms [15–17] and feel more able to help with physical rather than psychological problems [18]. Moreover, patients do not tend to report on psychological problems to their physician, because they often feel embarrassed to report, for example, depressive symptoms [19]. Thus both patients and physicians are reluctant to discuss psychological problems [20]. The growing awareness of the need to identify psychosocial problems among patients in cancer care has led to the development of screening instruments [21] to prevent the under-diagnosis of Patient Education and Counseling 93 (2013) 289–297 A R T I C L E I N F O Article history: Received 17 December 2012 Received in revised form 7 June 2013 Accepted 23 June 2013 Keywords: Distress Screening Oncology Cancer Communication A B S T R A C T Objective: This study tests whether using a screening instrument improves referral to psychosocial care providers (e.g. psychologist) and facilitates patient–radiotherapist communication. Methods: A cluster randomized controlled trial was used. Fourteen radiotherapists were randomly allocated to the experimental or control group and 568 of their patients received care in accordance with the group to which their radiotherapist was allocated. Patients in the experimental group were asked to complete a screening instrument before and at the end of the radiation treatment period. All patients were requested to complete questionnaires concerning patient–physician communication after the first consultation and concerning psychosocial care 3 and 12 months post-intervention. Results: Patients who completed the screening instrument were referred to social workers at an earlier stage than patients who did not (P < 0.01). No effects were observed for numbers of referred patients, or for improved patient–radiotherapist communication. Conclusions: Our results suggest that a simple screening procedure can be valuable for the timely treatment of psychosocial problems in patients. Future efforts should be directed at appropriate timing of screening and enhancing physicians’ awareness regarding the importance of identifying, discussing and treating psychosocial problems in cancer patients. Practice implications: Psychosocial screening can be enhanced by effective radiotherapist–patient communication. ß 2013 Elsevier Ireland Ltd. All rights reserved. § Results were presented in part of a PhD-thesis: Ray of light. Evaluating the feasibility and effectiveness of routine psychosocial screening in cancer patients receiving radiotherapy. June 2012. Anna P.B.M. (Vivian) Braeken. * Corresponding author at: Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Dr. Tanslaan 12, 6229ET Maastricht, The Netherlands. Tel.: +31 088 4455624; fax: +31 0884455776. E-mail address: vivian.braeken@maastro.nl (Anna P.B.M. Braeken). Contents lists available at ScienceDirect Patient Education and Counseling jo ur n al h o mep ag e: w ww .elsevier .co m /loc ate/p ated u co u 0738-3991/$ – see front matter ß 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2013.06.015