The effects of multi-disciplinary psycho-social care on socio-economic problems in cancer patients: a cluster-randomized trial
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We examined whether multi-disciplinary stepped psycho-social care decreases financial problems and improves return-to-work in cancer patients.
In a university hospital, wards were randomly allocated to either stepped or standard care. Stepped care comprised screening for financial problems, consultation between doctor and patient, and the provision of social service. Outcomes were financial problems at the time of discharge and return-to-work in patients < 65 years old half a year after baseline. The analysis employed mixed-effect multivariate regression modeling.
Thirteen wards were randomized and 1012 patients participated (n = 570 in stepped care and n = 442 in standard care). Those who reported financial problems at baseline were less likely to have financial problems at discharge when they had received stepped care (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.1, 0.7; p = 0.01). There was no evidence for an effect of stepped care on financial problems in patients without such problems at baseline (OR 1.1, CI 0.5, 2.6; p = 0.82). There were 399 patients < 65 years old who were not retired at baseline. In this group, there was no evidence for an effect of stepped care on being employed half a year after baseline (OR 0.7, CI 0.3, 2.0; p = 0.52).
Financial problems can be avoided more effectively with multi-disciplinary stepped psycho-social care than with standard care in patients who have such problems.
KeywordsRandomized controlled trial Cluster-randomized trial Clinical trial Social work Financial hardship Return-to-work
We would like to acknowledge the time and effort of all doctors and nurses who helped in implementing this trial into daily routine in a large university hospital. We are also very grateful to all patients who participated in this trial.
Access to data
Susanne Singer had full access to all the data in the study and takes responsibility for the integrity of the data, the accuracy of the data analysis, and the decision to submit for publication. She also planned and conducted the data analysis.
This trial was funded by the German Federal Ministry of Health within the framework “Research within the German National Cancer Plan” (no. NKP-332-026). The grant provided salary support for Helge Danker and Julia Roick.
Compliance with ethical standards
Ethical approval was granted by the University Medical Center Leipzig (no. 210-12-02072012).
Conflict of interest
We declare that there are no conflicts of interest.
The German Federal Ministry of Health did not influence the trial design and procedures or the writing of this manuscript or the decision to submit it for publication.
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