Oncology professionals' views on the use of antidepressants in cancer patients: a qualitative interview study
- Patricia Holch1,
- Kate L Absolom1,
- Simon Pini1,
- Kate M Hill1,2,
- Alan Liu1,3,
- Michael Sharpe4,
- Alison Richardson5,
- Christian Hosker6 and
- Galina Velikova1 on behalf of the NCRI COMPASS Supportive and Palliative Care Collaborative
- 1Cancer Research UK Psychosocial Oncology and Clinical Practice Research Group, St James Institute of Oncology, University of Leeds, Leeds, UK
- 2Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- 3Head & Neck Cancer Research Group, Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- 4Psychological Medicine Research, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
- 5Cancer Nursing and End of Life Care, Southampton University Hospitals NHS Trust and the University of Southampton, Southampton General Hospital, Southampton, UK
- 6Liaison Psychiatry, Becklin Centre, St James University Hospital, Leeds, UK
- Correspondence to Dr Patricia Holch, Cancer Research UK Psychosocial Oncology and Clinical Practice Research Group, St James Institute of Oncology, University of Leeds, Leeds LS9 7TF, UK;
Contributors All authors gave final approval for submission. PH assisted with the analysis and drafted and revised the paper; KLA developed the protocol, was involved in data collection, led the analysis and substantially contributed to critically revising the paper; SP was involved in data collection, assisted with analysis and contributed to critically revising the paper; KMH developed the protocol, devised the interview schedules and contributed to critically revising the paper; AL was involved with preparation of the protocol and data collection and contributed to critically revising the paper; MS and AR provided advice on the concept and original protocol and contributed to critically revising the paper; CH provided advice on analysis and interpretation of results and on critically revising the paper; GV contributed to the overall concept and design of the study, analysis and interpretation of results and critical revisions of the paper.
Objectives Emotional distress, including depression, is an important issue for cancer patients and their families. Guidelines recommend the use of antidepressant drugs (ADs) for the management of depression in cancer. This study explores the views of oncology professionals about the inclusion of ADs in treatment plans.
Design Semi-structured interview study. Data were analysed using framework analysis.
Setting A specialist cancer centre and six district general hospitals across the Yorkshire Cancer Network.
Participants 18 randomly selected professionals from lung, breast, urology and colorectal cancer teams: oncologists (n=8), surgeons (n=3), clinical nurse specialists (n=2) and ward nurses (n=5).
Results Three main themes emerged relating to professionals' attitudes, knowledge and behaviour. Positive attitudes were primarily expressed by nurses. However, negative views were expressed about the potential for over-reliance on ADs, and their use constituting ‘giving in’. Doctors reported a lack of confidence in the use of and knowledge about ADs with an associated reluctance to prescribe. The general practitioner (GP) was regarded as the most appropriate professional to prescribe ADs.
Conclusions Cancer professionals highlighted a need for training in the appropriate use of ADs. Further, this research suggests that negative attitudes towards antidepressants may be a factor in their exclusion from treatment plans. The GP is seen to have a key prescribing role for AD therapy; however, it is unclear whether the GPs is asked to do this. This research raises questions about the adequacy of ADs in cancer care and to what extent the GP is able to meet this need.
Funding National Cancer Research Initiative SuPac 0004. GV and KLA are supported by the Cancer Research UK programme grant (C7775/A7424). Role of Study Sponsors: The study sponsors had no role in the study design; the collection, analysis and interpretation of data; the writing of the report; or in the decision to submit the paper for publication.
Competing interests None.
Ethical approval Leeds (East) Research Ethics Committee, 07/H1306/166, 10 April 2008.
Provenance and peer review Not commissioned; externally peer reviewed.
- Accepted 25 July 2011.
- Published Online First 25 August 2011
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions