PCQN QI Collaborative€¦ · 25.07.2017 · meditation for radiation therapy patients. B. 2 small trials show strong effect in patients with cancer who have mood disturbance and

PCQN QI Collaborative

Anxiety Screening & Improvement July 25, 2017

Agenda • Review data • PDSA worksheet - updates • Case discussions • Next steps

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12/1/2016 – 7/19/2017 • Patients screened for anxiety at time of first symptom assessment

PCQN Anxiety Data - Inpatient

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% of Patients Screened for Anxiety at First Assessment

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Anxiety Collaborative

12/1/2016 – 7/19/2017 • Patients screened for anxiety at time of first symptom assessment


12/1/2016 – 7/19/2017 • Patients screened for anxiety during course of consultation.


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% of Patients Screened for at least 1x

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12/1/2017 – 7/19/2017 • Patients screened for anxiety during course of consultation.


12/1/2016 –7/19/207 • Improvement from 1st to 2nd assessment:


• 83.6% of patients improved from 1st to last assessment

% Improvement – First to Second Assessment

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0%

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12/1/2016 –7/19/207 • Improvement from 1st to 2nd assessment:


• 83.6% of patients improved from 1st to last assessment

Project Updates

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UCSF Example

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UCSF Example

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Case Discussions

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Non-pharm treatments for anxiety

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Intervention Summary USPTF Grade

Technical Notes

Meditation It’s unclear if meditation helps with diagnosed anxiety disorders (grade C for diagnosed anxiety), but in cancer patients meditation seems to help with as few as two sessions. One RCT, n = 90, showed that mindfulness based meditation was effective at decreasing mood disturbance and stress symptoms in cancer outpatients, and benefits were sustained at 6 months. Another trial found that meditation more effective than no meditation for radiation therapy patients.

B 2 small trials show strong effect in patients with cancer who have mood disturbance and anxiety symptoms but not diagnosed anxiety.

Yoga for anxiety A Cochrane review and another meta-analysis concluded that yoga is more effective than no treatment for anxiety.

B Strong evidence of effectiveness compared to no treatment, but effectiveness compared to other treatments is not clear.

Deep breathing exercise

Breathing Techniques were shown to reduce anxiety or distress in patients in some studies of palliative care patients, stem cell transplant patients and asthma patients.

C Evidence of effectiveness from multiple small studies in different populations, but evidence in palliative care patients is limited.

Guided Imagery Few studies in PC population, however, one small study shows effectiveness for depression but not anxiety

C Only one small study shows effectiveness for depression in palliative care patient population.


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Technical Notes

Acupuncture

A 2013 review found that there was insufficient/conflicting evidence to determine the effectiveness of acupuncture for depression/anxiety in cancer patients. No other relevant results were found.

I

Evidence is insufficient/conflicting

Craniosacral Therapy

No sources found I No evidence found

Essential Oils Some small studies show effects of essential oil aromatherapy and massage in reducing anxiety and depression in hospice patients, perioperatively, during hemodialysis, and in critically ill patients, however the evidence is not strong enough to recommend.

I Insufficient evidence to recommend, but preliminary results suggest possible effectiveness.

Homeopathy Multiple reviews conclude that evidence is insufficient to make conclusions about the effectiveness of homeopathy for anxiety and depression. Some anecdotal studies, and non-blinded studies show benefit, but few RCTs that are underpowered are insufficient evidence.

I Evidence is insufficient/conflicting


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Technical Notes

Cognitive Behavioral Therapy (CBT)

Level I evidence (at least 2 RCTs) showed efficacy of CBT for depressive symptoms in chemotherapy and metastatic cancer patients, and at least one trial showed efficacy for major depressive disorder. CBT was also found to be effective for depressive symptoms in at least 1 RCT for radiotherapy and post-treatment cancer pts.

A Strong evidence of efficacy from multiple trials for treating depression in cancer patients undergoing chemotherapy and radiation therapy.

Counseling/psychotherapy

A 2006 review found 2 RCTs that show counseling/psychotherapy is effective for depressive symptoms in cancer patients and notes one study that found it effective for major depression and others that did not.

B/C Several smaller studies show effectiveness for depressive symptoms but evidence for major depression is insufficient/conflicting

Support Groups Generally have been found to reduce depressive symptoms in multiple RCTs, although there are some negative results.

B


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Technical Notes

Yoga for depression

A 2010 review found a variety of studies showing that yoga interventions reduced depressive symptoms in patients with major depressive disorder (not geriatric or palliative care patients). A meta-analysis in a questionably reputable journal of two trials (n total = 140) found yoga to be more effective than a placebo at reducing depressive symptoms in cancer patients. An interesting note about yoga – several papers report that even when yoga was not found to improve anxiety or depression symptoms patients still self-reported improvement. One study found that there were social and quality of life benefits to participating in yoga for breast cancer patients, especially if not receiving chemotherapy (n = 120).

C Yoga has been found to be effective for major depressive disorder, however not in palliative care patients, and evidence in palliative patients is not high quality.

Pledges!

• What is one thing you can try in the next week to help you better understand or improve your patients’ anxiety?

Thank you!

See you on the next QI collaborative call: August 29 at 12:00pm PST

Kara Bischoff: [email protected]

Angela Marks: [email protected] Rachel Stone: [email protected]

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mailto:[email protected]



PCQN QI Collaborative€¦ · 25.07.2017 · meditation for radiation therapy patients. B. 2 small trials show strong effect in patients with cancer who have mood disturbance and

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