There is a consensus that diagnosis and treatment of cancer contributes to psychological distress and anxiety among patients [1–3]. The literature has demonstrated that information can reduce distress by enhancing patients' sense of control. An enhanced sense of control, in turn, relieves anxiety and enhances management of illness . Although the need for information exists across the continuum of cancer care [5, 6] the anxiety can be particularly pronounced at the initial visit to a cancer centre [7, 8]. Factors contributing to this anxiety and distress can be the lack of familiarity with the environment and with the care providers.
Researchers have investigated interventions with the aim of reducing the anxiety and distress levels among cancer patients [4, 9]. One of these interventions includes orientation programs for patients who are newly registered to a cancer service. A study of 150 new cancer patients by McQuellon and research team reported that their orientation was effective in reducing anxiety, distress and depressive symptoms and enhanced knowledge and satisfaction of care . In 2003, Gallant (2003) tested different methods of delivering an orientation program and found that it was more challenging to recruit patients for the face to face arms compared to the mail group . The components of these orientation programs vary and generally include question and answer sessions, a clinic tour, description of procedures, provision of information. However, none of these studies have investigated the effects of orientation programs and were not conducted by a multidisciplinary team.
In the population other than cancer patients, researchers have demonstrated that self-efficacy can be enhanced through orientation and educational programs, and that higher self-efficacy is related to improved health outcomes [12–15]. Self-efficacy is a construct of Bandura's social cognitive theory [16, 17], defined as a person's belief that they can perform the specific behaviours necessary to achieve their goals. A person's sense of self-efficacy should lead to attempting and persisting when encountering difficulties; their confidence in or perception of their ability to carry out tasks directly relates to their likelihood of success . A variety of research on cancer patients' self-efficacy has been conducted [19–23]. Self-efficacy is a potent factor which can affect the quality of life in cancer patients. Firstly, enhanced self-efficacy directly affects quality of life positively. Secondly, it reduces perceived stress and, in turn, increases quality of life . That is, cancer patients with higher self-efficacy have lower level of anxiety and distress and higher quality of life [21, 23, 24]. Therefore, interventions with the aim of increasing ones' self-efficacy are recommended.
Multidisciplinary team involvement
A systematic review reported that multidisciplinary care can result in positive patient outcomes , specifically in diagnosis and/or treatment planning [26–28], survival [29–31], patient satisfaction , communication and cooperation . Although there is a vast body of literature supporting the positive outcomes as a result of multidisciplinary care, there is a paucity of evidence which demonstrates the importance of multidisciplinary involvement in conducting orientation programs for cancer patients. While evidence suggests that unfamiliarity with the care providers is one of the factors contributing to this anxiety and distress in this patient population , it is important to note that "care providers" should include every member that the patients will access care from during the continuum of cancer care. Orientation provided for cancer patients should no longer be limited to "meeting the oncologist". As the model of care has changed from a medical focus to a multidisciplinary model, health professionals conducting orientation programs should also respond to the change. However, the orientation programs documented in the literature are mainly conducted by one nurse coordinator, rather than a multidisciplinary team [10, 33, 34]. Therefore, research is needed to evaluate the effectiveness of an orientation program conducted by a multidisciplinary team.
Objective of the study and the current paper
The main objectives of the study are
1. To develop an orientation program conducted by a multidisciplinary team for newly registered cancer patients in terms of its impacts on the patients' self-efficacy and anxiety.
2. To test the feasibility of a randomised controlled trial of an orientation program conducted by a multidisciplinary team for all newly registered cancer patients.
3. To evaluate the effectiveness of the program on patients' self-efficacy, anxiety, stress and informational awareness.
The current paper presents the design of the randomised controlled trial that will evaluate an orientation program conducted by a multidisciplinary team for newly registered cancer patients