Psychosocial interventions for cancer: Review and analysis using a three-tiered outcomes model

This study describes a three-tiered measurement model for psychosocial inte rventions with cancer patients and compares this model to extant measuremen t strategies. Progress has been made toward demonstrating that psychosocial interventions reduce depression, anxiety, functional impairment, and sympt oms. However, Chambless and Hollon (1998) note that the literature on psych osocial interventions for cancer fails to meet criteria for establishing tr eatment 'efficacy' and does not address issues of cost-effectiveness. The l ack of a timely model of clinical outcomes may be hindering demonstration o f efficacy and wider implementation of these interventions. Outcomes assess ed by 65 interventions were classified as Global Health Outcomes (medical e ndpoints, health-related quality of life (HRQOL), or resource utilization), Dimensions of HRQOL (distress, symptoms, functional ability, or interperso nal well-being), or Mechanisms of Action (evaluation of psychological or ph ysiological processes). A total of 28% of reviewed studies assessed Global Outcomes, 82% assessed Dimensions of HRQOL, and 49% assessed Mechanisms of Action. While most studies assessed patients' symptoms and distress, measur ements of resource utilization, HRQOL, and interpersonal HRQOL were under-r eported. A greater emphasis on treatment costs, quality of life, and mediat ing/moderating processes associated with improvement in outcomes could info rm decisions regarding allocation of health-care resources and lead to more widely available and efficient interventions for patients. Copyright (C) 2 001 John Wiley & Sons, Ltd.