Background: Prehabilitation aims to optimise patients’ physical and psychological readiness for surgery. Evidence for exercise-based prehabilitation is well-established, but evidence on the effectiveness of embedded psychological therapy in cancer prehabilitation remains limited.Aims: To evaluate whether brief, rapid‑response psychological therapy embedded within a multimodal cancer prehabilitation pathway improves mental health and functional outcomes, and to compare outcomes for patients who received specialist psychological support versus those who did not .Methods: This study applied a non‑randomised, prospective cohort comparison design using routine data from two UK NHS multimodal prehabilitation services. Participants were cancer patients using the prehabilitation pathway who reported clinically significant symptoms of anxiety and/or depression. Analysis 1 examined longitudinal change in depression and anxiety in patients referred for specialist psy chological support (n = 135) across baseline, mid‑therapy, and post‑intervention. Analysis 2 compared standardised mean differences in affective and functional outcomes for patients who accessed psychological support (n = 60) with eligible patients who declined (n = 418).Results: In Analysis 1, mean depression scores decreased by 54.1% and anxiety by 39.2%, with recovery rates comparable to and achieved in fewer sessions than national benchmarks for NHS Talking Therapies. In Analysis 2, both groups improved across all measures; standardised mean differences were numerically larger in the supported group for depression, anxiety, and sit‑to‑stand assessments. Conclusions: Initial indications suggest that embedding brief psychological input within prehabilitation is associated with clinically meaningful improvements in both mental health and functional outcomes linked to recovery. F urther research with randomised controlled designs is warranted to confirm causality and inform implementation.

Background: Prehabilitation aims to optimise patients’ physical and psychological readiness for surgery. Evidence for exercise-based prehabilitation is well-established, but evidence on the effectiveness of embedded psychological therapy in cancer prehabilitation remains limited. Aims: To evaluate whether brief, rapid‑response psychological therapy embedded within a multimodal cancer prehabilitation pathway improves mental health and functional outcomes, and to compare outcomes for patients who received specialist psychological support versus those who did not . Methods: This study applied a non‑randomised, prospective cohort comparison design using routine data from two UK NHS multimodal prehabilitation services. Participants were cancer patients using the prehabilitation pathway who reported clinically significant symptoms of anxiety and/or depression. Analysis 1 examined longitudinal change in depression and anxiety in patients referred for specialist psy chological support (n = 135) across baseline, mid‑therapy, and post‑intervention. Analysis 2 compared standardised mean differences in affective and functional outcomes for patients who accessed psychological support (n = 60) with eligible patients who declined (n = 418). Results: In Analysis 1, mean depression scores decreased by 54.1% and anxiety by 39.2%, with recovery rates comparable to and achieved in fewer sessions than national benchmarks for NHS Talking Therapies. In Analysis 2, both groups improved across all measures; standardised mean differences were numerically larger in the supported group for depression, anxiety, and sit‑to‑stand assessments. Conclusions: Initial indications suggest that embedding brief psychological input within prehabilitation is associated with clinically meaningful improvements in both mental health and functional outcomes linked to recovery. F urther research with randomised controlled designs is warranted to confirm causality and inform implementation.

Anxiety and depression are common among people living with and beyond cancer and frequently recur following the completion of psychological therapy. Digital interventions may offer a scalable and cost-effective means of supporting relapse prevention, but evidence in cancer populations remains limited. This study evaluated the feasibility, acceptability, and potential effectiveness of a personalized relapse prevention planning intervention supported by personalized smart-messaging following discharge from psychological therapy for cancer-related anxiety and depression. A naturalistic, non-randomized quasi-experimental cohort study was conducted within a National Health Service cancer psychology service in England. Patients completing psychological therapy could opt to receive a relapse prevention planning session followed by 26 weeks of personalized smart-messaging (relapse prevention planning [RPP]) or receive treatment as usual (TAU). Outcomes were assessed at discharge and 6- and 12-month follow-up using the Patient Health Questionnaire-9 (PHQ-9; primary outcome), Generalized Anxiety Disorder-7 (GAD-7), and Work and Social Adjustment Scale (WSAS). Linear mixed-effects models examined differences between groups over time while controlling for pre-treatment severity. Feasibility and acceptability were assessed through recruitment, retention, engagement, and withdrawal rates. Of 84 eligible patients approached, 57 (68%) consented to participate and 29 (56%) completed the final follow-up assessment. Engagement with smart-messaging was high: 92% of participants responded to at least one weekly prompt and there were no withdrawals from the messaging intervention. For depression, the RPP group demonstrated significantly lower PHQ-9 scores across follow-up than TAU (adjusted mean 6.08, SE 0.95 vs 10.46, SE 0.97; F1,44.9=9.90, P=.003). Significant between-group differences were observed at 6 months (mean difference 5.92, 95% CI 2.40-9.44; P=.001; d=1.08) and 12 months (mean difference 5.41, 95% CI 1.76-9.07; P=.005; d=1.06). The group × time interaction was not statistically significant (F2,36.3=2.73, P=.079). For anxiety, the RPP group reported lower GAD-7 scores than TAU (mean difference 3.80, 95% CI 1.35-6.25; F1,49.8=9.73, P=.003), although the interaction effect was not significant (F2,37.4=0.04, P=.965). Functional impairment showed a similar pattern, with a significant advantage for RPP at 6 months (mean difference 9.09; P=.029; d=1.16), but the overall group effect did not reach statistical significance (F1,20.0=4.08, P=.057). Personalized relapse prevention planning supported by smart-messaging was feasible, highly acceptable, and associated with sustained improvements in depression and anxiety following psychological therapy for cancer patients. Although findings are promising, the non-randomized design limits causal inference. A fully powered randomized controlled trial is warranted.

Psychological therapies are effective for several physical and mental health problems, but their overall effectiveness has not improved for over forty years. Technology development has applied the approach of benchmarking effectiveness to evaluate the combined impact of multiple adaptations, compared to best practice outcomes. However, this approach has been used little in psychological therapy research, when the pace of digitally enhanced adaptations may mean this approach adds value to the field. This study evaluated the clinical effectiveness and efficiency of a psychological therapy service model that employed multiple, digitally enhanced adaptations across the care pathway for those living with and beyond cancer, experiencing moderate-to-severe depression and/or anxiety. Service outcomes were benchmarked against an internationally recognized standard of best practice in the National Health Service Talking Therapies (NHS TT) program. Between 20th January 2022 and 31st March 2026, adults with a cancer diagnosis and significant anxiety and/or depression were referred to the East Midlands Cancer Alliance Centre for Psychosocial Health (EMCA CPH), The service incorporated seven adaptations to the care pathway to improve outcomes: (1) training and supervision of referrers; (2) a digitally enhanced therapy preparation intervention that also included (3) personalized smart-messaging reminders of patients’ motivations for therapy attendance, and (4) accommodation of patient preferences; (5) Routine Outcome Monitoring that applied dynamic algorithm-based predictions of patient prognosis to alert therapists to patients who may not improve; (6) use of session recordings to support therapists to deliberately practice their individualized skill growing edges, and (7) a digitally supported relapse prevention intervention that extended beyond discharge. Employing a longitudinal, time-series design, clinical outcomes for depression and anxiety (PHQ‑9, GAD‑7) were analysed using NHS TT definitions of reliable improvement, reliable recovery, and reliable deterioration. EMCA CPH performance was benchmarked against the 145 NHS TT services reporting 2024–25 data. Logistic regressions were used to identify any predictors of reliable improvement. Of 639 patients referred to EMCA CPH, 356 met criteria for the service and 282 (79%) provided follow-up data. The evaluated service achieved rates of reliable improvement (241/282, 85.5%) and recovery (166/277, 59.9%), above the 99th and 97th centiles respectively compared to benchmarked standard NHS TT services. The reliable deterioration rate reported (7/282, 2.5%) was lower than all 2024-25 NHS TT services. More severe baseline depression (OR=0.89, 95% CI [0.83, 0.94], P<.001) and longer waiting times (OR=0.99, 95% CI [0.98, 0.99], P=.012) predicted lower likelihood of reliable recovery. Psychological therapy provided by EMCA CPH, employing a range of digitally supported personalization methods and pathway innovations, obtained greater effectiveness and efficiency compared to NHS TT services. Further research is required to determine whether the personalization methods contributed to this improved performance or if it was due to other factors.

Background: Cancer patients experience elevated rates of depression and anxiety compared with the general population. Training cancer care staff to assess distress and deliver brief psychological interventions is effective, but the long-term impact is unclear. This is particularly relevant to the emerging method of deliberate practice in psychological support skills training that focuses on iterative rehearsal of skills with reduced didactic teaching. This study evaluated the long-term impact of brief, deliberate practice-based psychological support skills training and subsequent skills-focused supervision on cancer care staff’s assessment and intervention skills, mental wellbeing, work engagement, and burnout. Methods: A non-randomised, prospective, longitudinal design was applied across six UK National Health Service organisations. Cancer care staff who attended a two-day training and were invited to attend ongoing supervision completed follow-up measures up to four years post-training (n = 307). Multilevel linear mixed models examined change over time. Results: Large improvements in core skills were maintained at long-term follow-up (d = 1.34-1.96). Advanced skills showed initial large gains (d = 1.39) with partial attenuation over time (d = 0.79). Work engagement, burnout, and well-being were stable over time (ds between ≤0.18–0.26). Group supervision attendance was associated with greater improvement in core skills and stronger maintenance of advanced skills. Conclusions: Deliberate practice-based training is associated with durable improvements in psychological support skills up to four years post-training. Ongoing group supervision may enhance long-term skill consolidation. Such training may strengthen psychological support in cancer care.

INTRODUCTION:Depression is up to four times more common among individuals with cancer compared with the general population. Psychological therapies are effective in treating depression among patients in cancer care, but access is often delayed, which can exacerbate symptoms, increase dropout and reduce therapeutic effectiveness. This study evaluates the clinical and cost-effectiveness of a therapy preparation intervention (TPI) designed to enhance engagement and outcomes among patients awaiting psychological therapy in cancer care. METHODS AND ANALYSIS:This study is a parallel-group, two-arm, multicentre, single-blind randomised controlled trial. A total of 150 adults (≥18 years) living with or beyond cancer and experiencing moderate-to-severe depression will be recruited from health services in the East Midlands region of England. Participants will be randomised (1:1) to receive either TPI plus treatment as usual (TAU) or TAU alone.The primary outcome is depression severity measured using the Patient Health Questionnaire 9-items (PHQ-9) over a 24-week follow-up. Secondary outcomes include anxiety, functioning, mental well-being, patient activation, readiness for change, health-related quality of life and health economics, and therapy engagement including attendance and dropout. Hope and in-session patient activation, assessed using recorded treatment preparation sessions, will be explored as additional mechanistic variables. Health economic outcomes will be assessed at baseline and 24 weeks. Data will be collected via online or telephone surveys at baseline, and at 4, 8, 12 and 24 weeks post randomisation. Qualitative interviews with a subset of participants will explore intervention experiences, analysed using reflexive thematic analysis. ETHICS AND DISSEMINATION:Ethical approval has been obtained from the Health Research Authority and National Health Service Research Ethics Committee (Bromley) (REC reference: 24/LO/0610). Findings will be disseminated through peer-reviewed journals, academic conferences and clinical and patient networks. TRIAL REGISTRATION NUMBER:ISRCTN registry: ISRCTN13692666, registered on 18 October 2024.

Background:Despite improved survival rates, cancer patients often face physical and mental health challenges during and post-treatment. With cancer care services under pressure, these issues may go unnoticed. Holistic Needs Assessments attempt to address such problems but can have limited impact, necessitating corresponding interventions. Automated, personalised text-messaging interventions, successful in health monitoring, may be an effective solution but evidence is lacking on their integration into cancer care settings. Objective:To explore the feasibility and engagement in personalised smart-messaging programmes to manage common cancer-related issues. Methods:Recruitment occurred via clinician referrals and flyers in cancer care services. Qualitative and quantitative methods explored engagement data, clinical outcome measures, and qualitative interviews. A workshop involving patients and referring staff explored factors affecting programme implementation. Results:Twenty-seven patients enrolled, exhibiting varied engagement levels. Some participants reported symptom reduction particularly linked to higher engagement. The analysis of qualitative interviews on participant experience of the programmes resulted in themes related to enrolment rationale, sustaining engagement, and participation outcomes; and factors facilitating engagement included the practical and psychological dimensions of programme delivery. Twenty-seven participants responded to 49.95% of messages where responses were possible across 42.90% of enrolled days. The workshop emphasised the need for improved promotional materials and staff training. Conclusion:A tailored text messaging intervention shows promise in alleviating cancer-related symptoms, yet enrolment and active engagement remain obstacles. Enhanced promotional strategies are required to increase programme visibility and impact. Further research and integration into routine care are recommended.

This study explored participant-reported facilitators and barriers to learning and implementation from a 2-day training in psychological assessment and intervention skills for cancer staff, involving deliberate practice and supervision. Twenty-six semi-structured interviews were analysed using thematic analysis leading to four meta-themes: perceived practicality of training, impact of training: practice and its effects, implementation transfer processes and supervision engagement. Analysis identified a learning process to implementation: observation and practice of techniques during training facilitated participant learning; personal use and relevance of training content encouraged reflection, which enabled selection of appropriate tools for clinical practice; gains in commitment and confidence to use techniques supported participants to adapt clinical consultations, and supervision further facilitated implementation. Changing practice increased confidence, sense of achievement and engagement with participants' own wellbeing. Interactive training, deliberate practice and continuous learning were facilitators to implementation whilst time constraint and low confidence in using techniques in remote consultations were barriers.

Objectives: Guidelines recommend knee osteoarthritis pain management based on biopsychosocial mechanisms. Treatment adherence and effectiveness may be affected if there is a mismatch between patient perspectives and treatment focus. We therefore examined patient perspectives on mechanisms of their knee pain, why it persisted or changed over the past year, whether their understanding had changed, and whether their understanding aligned with that of others with whom they interact. Methods: Individuals with chronic knee pain (n 1/4 50) were purposively recruited from the Knee Pain and related health In the Community (KPIC) cohort to represent worsened, improved, or unchanged pain or anxiety between baseline and one year later. Framework analysis, a comparative form of thematic analysis, was used across transcripts of semi-structured telephone interviews. Results: Data were collapsed into themes of diagnosis, joint structure, ageing, physical activity, weight management, and treatment. Participants focused on biomechanical rather than psychological pain mechanisms. Some participants attributed pain improvement to increased and others to decreased physical activity. Participants reported no change in their understanding of their pain during the preceding year, but that their attitudes to pain, for example acceptance, had changed. Participants reported that they and others around them lacked understanding of their pain and why it did or did not change. Conclusion: People report a predominantly biomechanical understanding of why their knee pain remains constant or changes over time. Clinicians should support patients to develop a biopsychosocial understanding of knee pain aligned to treatment across the range of biological, psychological, and social modalities.

A relatively small amount of time is committed to improving psychosocial support skills among clinicians in cancer care. This is problematic given the high prevalence of mental health problems among patients in cancer care, which can have implications for treatment concordance, patient experience and care costs. Improving psychosocial support skills in cancer care staff can contribute to improved staff well-being alongside benefitting patients with mental health problems. There are well-evidenced programmes to support this. However, many education programmes for psychosocial skills in cancer care (e.g., advanced communication skills training) have protocols that can be too lengthy to implement alongside training more directly related to cancer diagnosis and treatment. An innovative education programme was trialled to improve the efficiency and effectiveness of psychosocial support skill acquisition and implementation among cancer care clinicians. This programme was novel in its incorporation of deliberate practice (DP): an approach used to achieve expertise in disciplines such as sport and music. It involves observing baseline skill level, identifying clinicians' individualised, specific microskill deficits, then conducting focused practice of targeted microskills with real-time feedback. Although similar methods are used in other areas of medical education, the approach has only recently been applied to psychosocial support skills1; this was the first application in cancer care. The programme also focused on brief psychosocial therapeutic techniques that clinicians could apply to their own lives in DP as well as with patients. This incorporated genuine responses during DP ‘real-plays’ and allowed clinicians to experience the potential benefits to well-being that each technique offered. The approach was facilitated by using evidence-based psychosocial support methods that aimed to improve universal human processes: Techniques to address problems that are part of the human condition rather than processes only seen in mental disorders. Over two training days, trainers applied each skill to a genuine concern in their own life (that they were comfortable discussing), facilitated by their co-trainer. Clinicians were involved in refinement processes of this real-play and DP demonstration through feedback and discussions. Clinicians then practiced each technique in threes: one practicing skills, one real-playing their problem and one observing. Learning from these training days was consolidated with facilitated, one-hour, monthly, DP-orientated group supervision. The programme was attended by 145 cancer care clinicians who reported improvements in psychosocial assessment and intervention skills at 8-month follow-up from pre-training with a very large effect size. Clinicians also reported significant improvements in mental well-being, work engagement and burnout. Twenty-six clinicians were interviewed about their training experience. Notably, 21 of 26 interviewees reported that observing real-plays and considering the relevance of techniques to their personal circumstances were important and helpful part of the process towards implementation in practice. However, only 27% of clinicians attended monthly supervision sessions, suggesting that greater improvements could be obtained with protected attendance time allocated. Overall, using DP to help clinicians apply psychosocial support skills to their own lives supported improvement in skills, well-being and implementation to practice.

ObjectivePsychological support skills training has the potential to improve both the ability of cancer staff to help their patients, and staff wellbeing. However, few recent studies have assessed both these outcomes or incorporated current developments in psychological skills training, such as deliberate practice, which includes the use of iterative, corrective feedback to identify and improve individualised skill deficits. No studies have evaluated the contribution that psychological skills training could make to cancer care staff wellbeing and expertise in the wake of the COVID-19 pandemic. This study aimed to evaluate staff skill acquisition and work-related wellbeing following psychological support skills training that applied deliberate practice principles. MethodA 2-day training and monthly supervision was offered to 145 cancer care staff that focused on brief assessment and intervention skills for patients experiencing mental health problems after cancer diagnosis and treatment. Deliberate practice principles were used to focus training on skills practice and feedback, over technique description. Self-reported ability to perform key skills taught, staff mental wellbeing, work engagement, and burnout were assessed at baseline, 3-month and 8-month follow-up. ResultsSignificant improvements in skills, mental wellbeing, burnout and work engagement were reported at 8-month follow-up. Full engagement in both training sessions was predicted by poorer baseline mental wellbeing, more positive evaluation of initial training, supervision attendance, and shorter follow-up. ConclusionA 2-day psychological support skills training using deliberate practice principles may support improvement in staff skill, mental wellbeing, burnout and work engagement.

Objective Acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy are types of cognitive-behavioural therapy (CBT) group that improve physical and mental health in chronic pain or cancer. However, dropout is high due to group demands alongside physical impairments. Motivational interviewing (MI) is a well-evidenced means of enhancing treatment adherence. Few studies have investigated MI as an adjunct to CBT in cancer or chronic pain, and none have established the minimum MI duration required for adherence improvement. This study evaluated minimal-duration MI to improve adherence in three CBT group types for cancer and chronic pain. Methods In a cohort study of 99 cancer and chronic pain patients, 47 were given a 10- to 15-min structured MI telephone intervention (MI-call) after the first session. The remaining 52 received a CBT group without MI (no-MI). Results Odds of completing group CBTs were five times greater for patients in the MI-call cohort versus no-MI. Effects remained when controlling for age, gender, diagnosis, group type, and baseline quality of life. The MI-call cohort attended one extra session per patient compared to no-MI, controlling for age, gender, and diagnosis. Conclusions A brief MI telephone intervention may improve adherence to group CBTs in cancer and chronic pain. Practitioner points A brief motivational interviewing (MI) telephone intervention may reduce dropout from group cognitive-behavioural therapies (CBTs) for cancer and chronic pain patients when administered after the first group session in routine care. Recipients of this intervention were five times more likely to complete a group CBT programme than those who did not receive it. Therefore, a minimal-dose MI intervention can have clinically important effects on dropout in group CBTs for patients with long-term conditions. It is unclear whether this intervention would also result in greater outcome improvements.

Acceptance and commitment therapy, mindfulness-based cognitive therapy, and problem-solving therapy are types of cognitive-behavioural therapy (CBT) group that improve physical and mental health in chronic pain or cancer. However, dropout is high due to group demands alongside physical impairments. Motivational interviewing (MI) is a well-evidenced means of enhancing treatment adherence. Few studies have investigated MI as an adjunct to CBT in cancer or chronic pain, and none have established the minimum MI duration required for adherence improvement. This study evaluated minimal-duration MI to improve adherence in three CBT group types for cancer and chronic pain. In a cohort study of 99 cancer and chronic pain patients, 47 were given a 10- to 15-min structured MI telephone intervention (MI-call) after the first session. The remaining 52 received a CBT group without MI (no-MI). Odds of completing group CBTs were five times greater for patients in the MI-call cohort versus no-MI. Effects remained when controlling for age, gender, diagnosis, group type, and baseline quality of life. The MI-call cohort attended one extra session per patient compared to no-MI, controlling for age, gender, and diagnosis. A brief MI telephone intervention may improve adherence to group CBTs in cancer and chronic pain.

ObjectivesTo assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR).DesignMedline, Embase, and PsycINFO were searched from inception to up to 9 May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short-term and long-term postoperative pain after TKR were included. Screening, data extraction, and assessment of methodological quality were performed in duplicate by two reviewers. The primary effectiveness outcome was postoperative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological well-being. Reporting standards were assessed using the Template for Intervention Description and Replication (TIDieR) checklist for intervention reporting.Results12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study), progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive–behavioural therapy (two studies), and a postoperative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR.ConclusionFurther evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute postoperative pain and chronic postoperative pain would be of benefit.PROSPERO registration numberCRD42018095100.

Gender differences in stroke outcome have implicated steroid hormones as potential neuroprotective candidates. However, no clinical trials examining hormone replacement therapy on outcome following ischemic stroke have investigated the effect of progesterone-only treatment. In this review the authors examine the experimental evidence for the neuroprotective potential of progesterone and give an insight into potential mechanisms of action following ischemic stroke. To date, 17 experimental studies have investigated the neuroprotective potential of progesterone for ischemic stroke in terms of ability to both reduce cell loss and increase functional Outcome. Of these 17 published studies the majority reported a beneficial effect with three studies reporting a nil effect and only one study reporting a negative effect. However, there are important issues that the authors address in this review in terms of the methodological quality of studies in relation to the STAIR recommendations. In terms of the proposed mechanisms of progesterone neuroprotection we show that progesterone is versatile and acts at Multiple targets to facilitate neuronal survival and minimize cell damage and loss. A large amount of experimental evidence indicates that progesterone is a neuroprotective candidate for ischemic stroke: however, to progress to clinical trial a number of key experimental studies remain outstanding.