A cluster randomized controlled trial of cognitive behaviour therapy for common mental disorders in patients with advanced cancer
Abstract
BACKGROUND: Cognitive behaviour therapy (CBT) has been shown to reduce psychological morbidity in people with cancer, but no randomized controlled trial (RCT) exists in palliative care. We aimed to determine whether home care nurses could be taught to deliver basic cognitive behavioural techniques and so reduce symptoms of anxiety and depression. METHOD: Clinical nurse specialists (CNSs) at St Christopher's Hospice were randomly allocated to receive training in CBT or continue their usual practice. At the end of the trial, nurses were rated on the Cognitive Therapy First Aid Rating Scale (CTFARS) for CBT competence. Home care patients who scored as possible cases on the Hospital Anxiety and Depression Scale (HADS) entered the trial. Participants received home care nursing visits. Assessments were carried out at baseline, 6, 10 and 16 weeks. RESULTS: Eight nurses received CBT training and seven continued practice as usual. The mean CTFARS scores were 35.9 for the CBT nurses and 19.0 for the controls (p=0.02). A total of 328 patients (54%) were possible cases and 80 entered the trial; most of those excluded were too ill to participate. There was an interaction between group and time: individuals receiving CBT had lower anxiety scores over time [coefficient -0.20, 95% confidence interval (CI) -0.35 to -0.05, p=0.01]. No effect of the training was found for depression. CONCLUSIONS: It is possible to conduct a randomized trial of psychological interventions in palliative care but there is considerable attrition from physical morbidity and mortality. Nurses can learn to integrate basic CBT methods into their clinical practice. This training may be associated with better outcomes for symptoms of anxiety.
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Prior reviews identified that face-to-face CBT provided some benefit in decreasing depressive and anxiety symptoms in advanced cancer.
“First, prior reviews identified that face-to-face CBT (individual (Moorey et al., 2009, Anderson et al., 2008) and group (Edelman et al., 1999)) provided some benefit in assisting those living with advanced cancer by decreasing depressive and anxiety symptoms (Greer et al., 2010; Moorey et al., 2009; Horne and Watson, 2011).”
From A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety (2021) · cites this paper as Moorey et al., 2009
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- Authors
- Moorey, S., Cort, E., Kapari, M., Monroe, B., Hansford, P., Mannix, K., Henderson, M., Fisher, L., & Hotopf, M.
- Affiliations
- South London and Maudsley NHS Foundation Trust (GB)
- St Christopher's Hospice (GB)
- King's College London (GB)
- Royal Victoria Infirmary (GB)
- Corresponding author
- Moorey, S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2008-09-02
- Volume
- 39
- Issue
- 5
- Pages
- 713-723
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2062557126
- Cited by
- 129
- References
- 30
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 6 · 2019: 7 · 2018: 4 · 2017: 6 · 2016: 8 · 2015: 6 · 2014: 12 · 2013: 10 · 2012: 15
- FWCI
- 9.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0507-10088)
- Gatsby Charitable Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- cognitive behavioral therapy, advanced cancer, palliative care, anxiety, depression, home care nursing, clinical nurse specialists, CBT training, psychological intervention, hospice care
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Anxiety Disorders, Clinical Competence, Depressive Disorder, Education, England, Female, Home Care Services, Hospices, Humans, Male, Middle Aged, Neoplasms, Nurse Clinicians, Palliative Care, Patient Dropouts, Personality Inventory, Psychometrics, Sick Role, Cognitive Behavioral Therapy, Cluster Analysis
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