Dr Bree Hobden

This scoping review examined the literature on co-occurring mental health conditions and substance use among Indigenous peoples globally across (i) time, (ii) types of conditions examined, (iii) countries, (iv) research designs, and (v) participants and settings. Medline, Embase, PsycInfo, and Web of Science were searched across all years up until October 2022 for relevant studies. Ninety-four studies were included, with publications demonstrating a slight and gradual increase over time. Depressive disorder and alcohol were the most examined co-occurring conditions. Most studies included Indigenous people from the United States (71%). Ninety-seven percent of the studies used quantitative descriptive designs, and most studies were conducted in Indigenous communities/reservations (35%). This review provides the first comprehensive exploration of research on co-occurring mental health and substance use conditions among Indigenous peoples. The information should be used to guide the development of strategies to improve treatment and prevention.

High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008¿2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.

Audit and feedback is commonly used as a method of both monitoring and attempting to improve the quality of healthcare. No review has examined the literature on systems-level audit and feedback strategies to improve the quality of oncology care. This scoping review examines the number, care focus (technical, nontechnical, or both) and methodological quality of published intervention studies which have used systems-level audit and feedback intended to improve the quality of care delivered in oncology treatment centers. Medline, Embase, PsycINFO, and the Cochrane database were searched, from inception to March 2021, for intervention studies which examined the effectiveness of systems-level audit and feedback in improving care for cancer patients. Studies which met the Effective Practice and Organization of Care (EPOC) minimum design criteria were then assessed using the EPOC risk of bias tool. Study characteristics and outcomes were extracted for those meeting methodological criteria. A narrative approach was used to synthesize the results. A total of 32 intervention studies met the inclusion criteria, of which 53% focused on technical aspects of care, 31% focused on nontechnical and 16% focused on both. Four of the included 32 studies met the EPOC minimum design criteria (13%). Most studies had a before-after study design (75%; n = 24) and methodological quality of the final four studies was moderate. Audit and feedback studies involving oncology treatment centers have primarily focused on technical care aspects. The low number and moderate methodological quality of the studies make it difficult to draw clear inferences about the effectiveness of systems-level audit and feedback. Furthermore, high-quality audit and feedback interventions are required across technical and nontechnical aspects of care to quantify the effectiveness of strategies for improving cancer care and ensure healthcare resources are being optimized.

Introduction: Community aged care services provide support to older adults living in their own homes. Cognitive impairment may increase the complexity of the support required. There is a need to ensure suitable brief screening tools are available to community aged care providers to assess possible cognitive impairment. This study aimed to examine the agreement between 2 validated cognitive impairment screening tools, the Mini-Cog, and Abbreviated Mental Test Score (AMTS), and the perceptions the individuals case manager of Case Manager¿s. Methods: A cross-sectional survey study was undertaken with clients of a community aged care provider. Clients were administered both the screening tools via an electronic survey by their Case Manager. Results: In total, 158 (54%) eligible participants consented to participate. There was a 70% agreement between the Mini-Cog and AMTS measures, indicating a moderate agreement which was not statistically different from chance (Kappa 0.08, 95% CI -0.04-0.19). Case Managers identified 37% (n = 48/130) of participants as possibly having cognitive impairment, of which, 15% (n = 20) were also identified via a screening tool. Conclusions: The findings indicate poor agreement across the 3 measures. To ensure adequate supports are offered to those with cognitive impairment, the use of validated tools that can be administered by non-medical staff in a community setting is a priority. This study highlights a need for further work to determine the most suitable tool for use by community-based aged care services.

Objective There are published guidelines on the care that should be provided to cancer patients upon finishing treatment (i.e. follow-up care). Gaps in care may arise where patients¿ reported experiences of care do not align with guideline recommendations. The aim of this study was to explore whether oncology patients report gaps in patient-centered follow-up care. Methods This study was a cross-sectional survey of adult cancer patients receiving follow-up care within four outpatient oncology clinics. Patients were approached in clinic waiting rooms and asked to complete an electronic survey. The survey examined patients¿ self-report of receiving six aspects of follow-up care. Results A total of 239 participants completed the survey (study consent rate = 83%). Only 49% of participants received all six items of care. Patients reported high rates of being told who to contact if they have any questions or concerns (95%); who to contact if signs or symptoms occur (91%); and what to expect in their follow-up care (90%). A lower proportion of patients indicated they were informed about the role of their GP after treatment has finished (79%); what symptoms or signs might suggest the cancer had returned (74%); or were given a written care plan (71%). Conclusions: The study highlights that there is a gap between some aspects of optimal patient-centered care, and the actual care received by patients. Health care providers and researchers should consider how to improve follow-up care experiences to ensure best practice cancer care delivery during this important stage in cancer survivorship.

Objective: Supportive care is recognised as an integral component of cancer care. To comprehensively improve supportive care and to inform policy, it is essential to examine consumer's views of health services. This study aimed to develop and test a patient-centred approach by measuring consumer perspectives on the importance of aspects of supportive care to determine what patients consider highest quality or ¿optimal¿ care. Methods: A cross-sectional survey was conducted in oncology outpatient clinics. Eligible patients were invited to complete the optimal care survey on an iPad. The survey consisted of 69 items assessing 14 care domains across five phases of the care trajectory. Results: A total of 359 participants completed the survey. Items in the ¿preparation for treatment¿ and ¿follow-up and end-of-life care¿ phases were endorsed as very important/essential to optimal care by most participants (79¿97% and 80¿100%, respectively). Items in the ¿preparation for first appointment¿ (48¿84%), ¿first appointment¿ (51¿97%) and ¿receiving treatment¿ (32¿93%) phases showed greater variation in endorsement. Conclusion: This study provides a patient-centred tool for quantifying optimal supportive care for people with cancer across the treatment trajectory. This tool could be used by healthcare providers to evaluate existing care quality, develop policies and guide clinical service improvements.

Background and Aims: The Brief Scale for Anxiety (BSA) and the State¿Trait Anxiety Inventory Form Y-2 (STAI-Y-2) are self-report scales used to gauge anxiety symptoms in clinical settings. Co-occuring anxiety is common in alcohol use disorder (AUD); however, no studies have assessed the validity of the BSA and STAI-Y-2 compared with a clinical diagnostic tool of anxiety in alcohol treatment programs. We aimed to examine the validity of the BSA and STAI-Y-2 to predict a clinical diagnosis of an anxiety disorder (via the Structured Clinical Interview for DSM [SCID]) in AUD patients. Design: Participants were administered the BSA (n¿=¿1005) on day 2 and the STAI-Y-2 (n¿=¿483) between days 2 and 10 of the detoxification program. SCID-based clinical diagnoses of AUD and anxiety were made approximately on day 10. Setting and participants: Individuals seeking treatment for AUD admitted to an inpatient unit at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD, USA (n¿=¿1010). Measurements: Inclusion criteria included a current diagnosis of alcohol dependence (AD) according to DSM-IV-TR or moderate to severe AUD according to DSM-5-RV, as well as available baseline BSA and/or STAI Y-2 data. Empirical receiver operating characteristic (ROC) curves were generated using estimates of sensitivity, 1-specificity and positive and negative predictive values for each cut-point to determine the accuracy of scale outcomes in relation to SCID diagnoses. Findings: The BSA demonstrated low accuracy relative to a clinical diagnosis of anxiety with an area under the curve (AUC) of 0.67 at the optimal cut-point of = 10. The STAI-Y-2 had moderate accuracy relative to a clinical diagnosis of anxiety with an AUC of 0.70 at the optimal cut-point of =¿51. The accuracy of the STAI-Y-2 increased (AUC¿=¿0.74) when excluding post-traumatic stress disorder and obsessive¿compulsive disorder from anxiety disorder classification. Conclusions: Use of the Brief Scale for Anxiety (BSA) and/or State¿Trait Anxiety Inventory Form Y-2 (STAI-Y-2) does not appear to be a reliable substitute for clinical diagnoses of anxiety disorder among inpatients with alcohol use disorder. The BSA and STAI-Y-2 could serve as a screening tool to reject the presence of anxiety disorders rather than for detecting an anxiety disorder.

Background: Despite their central role in patient care, few studies have explored cancer nurses¿ perspectives about errors within the health care system. Aims: To determine in a sample of cancer nurses the: (1) perceived accuracy of patient-reported health care error rates in medical oncology and haematology care; (2) extent to which nurses¿ perceive the health care system responds to errors in accord with best-practice disclosure standards; and (3) association between perceived barriers to disclosure of errors and years of experience, number of errors in previous six months and nursing role. Methods: Cross-sectional online survey of members of an oncology nursing society and/or registered or enrolled nurses employed in an oncology setting. Descriptive statistics including frequencies and proportions were calculated for all variables, and chi-square/Fisher's exact test was used to explore the association between perceived barriers to disclosure and several predictor variables. Findings: Ninety-seven nurses across the two cohorts completed the survey. Across the two cohorts, 36% and 27% of nurses perceived medical oncology and haematology patient-reported error rates to be accurate, respectively. Sixty-six percent agreed data should be routinely collected from patients; and 90% agreed data should be reported back to treatment centres. Nurses perceived patients were ¿always¿: given an apology (24%); able to ask questions (20%), told steps taken to prevent future errors (18%), told about errors when they happened (16%) and given honest explanations (17%). Barriers to error disclosure included burden of reporting (75%), fear career damage (74%), lack institutional support (65%), fear legal action (64%), no patient harm (58%) and not nurses¿ responsibility (27%). Discussion: Nurses did not consistently agree that previously-reported patient-reported error rates were accurate. Nurses agreed patient-reported data on health care error rates should be collected and fed back to treatment centres and that there is room for improvement with regard to adherence to open disclosure standards. Conclusion: System-level strategies are required to overcome barriers to disclosure.

Background: Continuous quality improvement in cancer care relies on the collection of accurate data on the quality of care provided. It is suggested that such an approach should: (i) measure the patient¿s care experience throughout the cancer trajectory; (ii) use items and response scales that measure concrete and specific aspects of care; (iii) minimise recall bias; (iv) minimise the burden placed on patients for providing data; (v) minimise administrative burden; and (vi) collect actionable data. The System for Patient Assessment of Cancer Experiences (SPACE) was developed to meet these objectives. This study describes the feasibility and acceptability of the SPACE in a sample of oncology outpatients. Methods: The SPACE was examined in four medical oncology centres. Adult patients were approached by a research assistant prior to their scheduled consultation. Consenting participants completed the SPACE on a computer tablet. Items were tailored to the patient¿s cancer treatment phase. Results: Of the eligible participants, 1143 consented (83%) and 1056 completed the survey (92%). The average time taken to complete the survey was 6¿min 28¿s. A large proportion of the sample indicated that the survey was acceptable (88¿93% across three acceptability items). Conclusion: This study demonstrates that the SPACE can be feasibly administered each time a patient comes to the oncology unit and is acceptable to patients. The SPACE could be used to quantify the care experiences which patients receive during their cancer care. The resulting data could be used to set benchmarks and improve the performance of cancer clinics.

This study examined the prevalence of and sociodemographic characteristics associated with elevated symptoms of depression among clients seeking alcohol or other drug (AOD) treatment. Consenting clients attending two AOD outpatient clinics answered demographics, treatment questions and the Patient Health Questionnaire to assess depressive symptoms. Counts and percentages were calculated to determine the prevalence of elevated depressive symptoms. Logistic regression was used to model the odds of having elevated depressive symptoms for client demographics. Of the 203 clients who completed the survey (87% consent rate), 55% (n = 111) demonstrated elevated depressive symptoms. Females were twice as likely to experience elevated symptoms of depression compared to males (OR 2.07; 95% CI 1.05, 4.08; P = 0.037). The high rates of elevated depressive symptoms among individuals seeking AOD treatment highlight the importance of ongoing research to provide effective treatments for this comorbidity. Routine screening and clear treatment pathways may assist with providing high quality care.

Introduction: There is a need to improve the psychosocial well-being of cancer patients. To date, intervention research has primarily focussed on improving psychosocial well-being through targeting singular aspects of care at the individual patient level. Sustainable, high-quality psychosocial care should address the issues faced by people diagnosed with cancer throughout the care pathway using a system-based approach. Aims: To examine the number of intervention trials attempting to improve psychosocial cancer care that have implemented a system-based approach. Method: Five journals were selected and relevant studies across all years were extracted. Four criteria, argued to be essential characteristics of system-based change, were assessed: (1) establishing a culture change within the healthcare system/organisation, through designated leaders who endorse organisational goals; (2) adopting a multidisciplinary approach to change; (3) mapping the system and identifying points of leverage; and (4) measuring the impact of change and adapting establish feedback loops. Results: The search strategy returned 1174 citations, of which five met the inclusion criteria. Of the intervention studies identified, three met none of the four defined criteria for a systems-based intervention, one study met criterion 2 only, and one study met all four criteria, however, was not a rigorous study design. Conclusions: This review of published psychosocial intervention trials in top-ranking psychosocial cancer care journals only found one study that met our criteria for evaluating system-based change. This is likely to be a consequence of the significant pragmatic and political barriers to conducting system-based intervention research.

Objective: Using a vignette-style DCE in a sample of oncology patients, this study explored: (1) the relative influence of the patient's level of concern about their depression on preferences for care, (2) the relative influence of depression severity according to a mental health checklist on preferred treatment-seeking options, and (3) whether patient age and gender were associated with depression care preference. Methods: A discrete choice experiment (DCE) survey of cancer patients was conducted. Hypothetical vignettes to elicit care preferences were created using two attributes: the cancer patient's level of concern about depression (a little or a great deal) and results of a mental health checklist (not depressed or very depressed). Three response options for care preferences were presented, including a self-directed approach, shared care approach, and clinician-directed referral approach. Participants chose their most and least preferred options. Results: A total of 281 cancer patients completed the survey. There was a significant association between level of concern and the most preferred option. Those with a great deal of concern about depression preferred to receive referral from their clinician more than those with a little concern about depression. Males were significantly more likely to select a self-directed approach as their most preferred option. Conclusions: An oncology patient's level of concern about depression may influence the type of care they want to receive from their cancer doctor for depression. This finding has implications for depression screening in clinical practice.

Introduction: The detection of harmful alcohol use and the delivery of brief advice in primary care are less than optimal. Given limited health care resources, deciding where best to allocate funding to optimize health outcomes is imperative. A simple data-based tool could be useful when access to specialist health economic advice is unavailable. This study aimed to examine the utility of a simple data-based calculator to facilitate priority setting in general practice for reducing alcohol-related harm. Methods: A simple algorithm was developed within Microsoft Excel to allow comparison of hypothetical intervention scenarios that aimed to increase detection and brief advice for harmful alcohol use in general practice. The calculator accommodated varying implementation costs, size of effect and reach for each scenario created. The incremental costs of the intervention scenarios, the incremental number of successes (i.e. abstinence or drinking at safe levels) and the incremental costs-effectiveness ratio (ICER) were calculated for each hypothetical scenario and compared with a usual care scenario. Results: In the hypothetical scenarios modelled, increasing both the detection of harmful alcohol consumption and the provision of brief advice produced the greatest number of incremental successes above baseline. Increasing detection alone produced fewer incremental successes but was the most cost-effective approach, as indicated by the lowest ICER. Discussion: The data-based calculator provides a simple method of exploring reach and cost-effectiveness outcomes without the need for any specific skills. Although this approach has limitations, the calculator can be used by decision makers to guide intervention planning.

The negative health consequences of tobacco and risky alcohol consumption are compounded when used concurrently. Australian preventative health guidelines recommend that general practitioners (GPs) assess and provide evidence-based intervention. No studies, however, have examined the accuracy of GP detection of concurrent tobacco use and risky alcohol consumption or the factors associated with accurate detection. This study aimed to examine the: (i) accuracy of GP detection of concurrent tobacco and risky alcohol use compared to patient self-report and (ii) GP and patient characteristics associated with accurate detection following a single clinical encounter. Patients attending 12 Australian general practices completed a survey assessing smoking and alcohol consumption. For each participating patient, GPs completed a checklist to indicate the presence of these risk factors. GP judgements were compared to patient self-report. Fifty-one GPs completed a health risk checklist for 1332 patients. Only 23% of patients who self-reported concurrent tobacco and risky alcohol use identified by their GP. Patients who visited their GP four to six times in the last year were most likely to have concurrent tobacco and risky alcohol use were identified. It is imperative to establish systems to increase detection of preventative health risks in general practice to enable the provision of evidence-based treatments.

Objectives: Alcohol misuse and depression are commonly co-occurring conditions. To date, no review has examined the most efficacious treatment model for psychosocial treatment of co-occurring alcohol misuse and depression. This systematic review determined the: (i) methodological quality of publications examining psychosocial treatment of co-occurring alcohol misuse and depression using a sequential, parallel or integrated treatment model; and (ii) effectiveness of each dual treatment model compared to single treatment for those with co-occurring alcohol misuse and depression. Methods: PubMed, Medline and PsycInfo databases were searched for studies which were included if they involved treatment for alcohol misuse and depression and could be classified into one of the three treatment models. Included studies were assessed using the Cochrane¿s Effective Practice and Organisation of Care risk of bias criteria. Relevant study characteristics and outcomes were extracted and are presented in a narrative review format. Results: Seven studies met inclusion criteria. None were categorised as low risk on the risk of bias criteria. No studies examined a sequential model of treatment, three examined a parallel model and four examined an integrated model of dual-focussed treatment. The studies examining the parallel model and two out of four studies examining the effectiveness of an integrated model demonstrated greater improvement for alcohol or depression outcomes compared to control conditions. Conclusion: Evidence for the psychosocial treatment of co-occurring alcohol misuse and depression is limited to a handful of studies. The evidence has several methodological limitations, which impact the interpretation of the findings. Therefore, while international guidelines recommend integrated dual-focussed treatment for co-occurring conditions, there is little evidence supporting the superiority of this treatment format for co-occurring alcohol misuse and depression. High-quality research demonstrating improvements in patient outcomes is required to ensure recommendations for clinical practice are based on strong empirical evidence.

Depression and alcohol misuse are common co-occurring conditions. This study aimed to determine the accuracy of general practitioner identification of depression and alcohol misuse. Participants from 12 Australian general practices reported demographic and health risk behaviour data. General practitioners were asked to indicate the presence or absence of six health risk factors for individual patients. Accuracy of general practitioner identification was low at 21 per cent. Those with severe alcohol misuse, no chronic diseases and lower education levels were more likely to be identified. Routine screening prior to patient appointments may be a simple and efficient way to increase identification rates.

Objective Both computerised and telephone surveys have potential advantages for research data collection. The current study aimed to determine the: (i) feasibility, (ii) acceptability, and (iii) cost per completed survey of computer tablet versus telephone data collection for clients attending an outpatient drug and alcohol treatment clinic. Design Two-arm randomised controlled trial. Method Clients attending a drug and alcohol outpatient clinic in New South Wales, Australia, were randomised to complete a baseline survey via computer tablet in the clinic or via telephone interview within two weeks of their appointment. All participants completed a three-month follow-up survey via telephone. Results Consent and completion rates for the baseline survey were significantly higher in the computer tablet condition. The time taken to complete the computer tablet survey was lower (11¿min) than the telephone condition (17¿min). There were no differences in the proportion of consenters or completed follow-up surveys between the two conditions at the 3-month follow-up. Acceptability was high across both modes of data collection. The cost of the computer tablet condition was $67.52 greater per completed survey than the telephone condition. Conclusion There is a trade-off between computer tablet and telephone data collection. While both data collection methods were acceptable to participants, the computer tablet condition resulted in higher consent and completion rates at baseline, therefore yielding greater external validity, and was quicker for participants to complete. Telephone data collection was however, more cost-effective. Researchers should carefully consider the mode of data collection that suits individual study needs.

Objectives To examine the: 1) methodological quality of interventions examining strategies to improve patient-practitioner communication involving treatment decisions; 2) effectiveness of strategies to improve patient-practitioner communication involving treatment decisions; and 3) types of treatment decisions (emergency/non-emergency) in the included studies. Methods Medline, PsychINFO, CINAHL, and Embase were searched to identify intervention studies. To be included, studies were required to examine patient-practitioner communication related to decision making about treatment. Study methodological quality was assessed using Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Study design, sample characteristics, intervention details, and outcomes were extracted. Results Eleven studies met the inclusion criteria. No studies were rated low risk on all nine risk of bias criteria. Two of the three interventions aimed at changing patient behaviour, two of the five practitioner directed, and one of the three patient-practitioner directed interventions demonstrated an effect on decision-making outcomes. No studies examined emergency treatment decisions. Conclusions Existing studies have a high risk of bias and are poorly reported. There is some evidence to suggest patient-directed interventions may be effective in improving decision-making outcomes. Practice implications It is imperative that an evidence-base is developed to inform clinical practice.

Limited data exist regarding co-occurring alcohol misuse and depression among general practice patients. This study examined the prevalence of depression by level of alcohol misuse, and the sociodemographic factors associated with depression and increased alcohol misuse severity. A cross-sectional survey was administered to 3559 Australian general practice patients. Patients completed their demographic details, the Patient Health Questionnaire (9-item) and the Alcohol Use Disorder Identification Test (Consumption items). The prevalence of alcohol misuse and depression was 6.7%, and depression prevalence varied significantly according to level of alcohol misuse (P<0.001). Age, gender, Aboriginality and number of chronic diseases were associated with depression and higher levels of alcohol misuse. These findings may assist General Practitioners in identifying those at risk of experiencing co-morbid depression and alcohol use, and aid in effective treatment and referral.

Background: Population-based registries are increasingly used to recruit patient samples for research, however, they have several limitations including low consent and participation rates, and potential selection bias. To improve access to samples for research, the utility of a new model of recruitment termed the 'Consumer Register', that allows for direct patient recruitment from hospitals, was examined. This paper reports: (i) consent rates onto the register; (ii) preferred methods and frequency of contact; and (iii) the feasibility of establishing the register, including: (a) cost per person recruited to the register; (b) the differential cost and consent rates of volunteer versus paid data collectors; and (c) participant completion rates. Methods: A cross-sectional survey was conducted in five outpatient clinics in Australia. Patients were approached by volunteers or paid data collectors and asked to complete a touch-screen electronic survey. Consenting individuals were asked to indicate their willingness and preferences for enrolment onto a research register. Descriptive statistics were used to examine patient preferences and linear regression used to model the success of volunteer versus paid data collectors. The opportunity and financial costs of establishing the register were calculated. Results: A total of 1947 patients (80.6 %) consented to complete the survey, of which, 1486 (76.3 %) completed the questionnaire. Of the completers, the majority (69.4 %, or 1032 participants) were willing to be listed on the register and preferred to be contacted by email (50.3 %). Almost 39 % of completers were willing to be contacted three or more times in a 12 month period. The annual opportunity cost of resources consumed by the register was valued at $37,187, giving an opportunity cost per person recruited to the register of $36. After amortising fixed costs, the annual financial outlay was $23,004 or $22 per person recruited to the register. Use of volunteer data collectors contributed to an annual saving of $14,183, however paid data collectors achieved significantly higher consent rates. Successful enrolment onto the register was completed for 42 % of the sample. Conclusions: A Consumer Register is a promising and feasible alternative to population-based registries, with the majority of participants willing to be contacted multiple times via low-resource methods such as email. There is an effectiveness/cost trade off in the use of paid versus volunteer data collectors.

Background: Supporting people after bereavement is a priority area for many health services. Investment in bereavement care must be supported by a rigorous evidence-base. Aim: To examine the (1) relative proportion of descriptive, measurement and intervention research in grief counselling and (2) quality and effectiveness of intervention studies. Design: Systematic review of studies published in the area of grief counselling. Data sources: MEDLINE, Embase, Cochrane Library and PsycINFO databases were searched for studies published between 2000 and 2013. Eligible papers were categorised into descriptive, measurement, review, commentaries and intervention studies. Intervention studies were assessed against the Cochrane Effective Practice and Organisation of Care methodological criteria, and papers meeting criteria were assessed for quality. The impact of interventions on grief, psychological morbidity and quality of life was examined. Results: A total of 126 data-based papers, including 47 descriptive, 3 measurement and 76 grief counselling intervention studies were included. Only 59% (n = 45) of intervention studies met Effective Practice and Organisation of Care design criteria. Overall, study quality was poor, with the majority of interventions showing a risk of bias in several key areas. The three studies that met all criteria showed mixed effectiveness. Conclusion: Grief counselling interventions require a strong rationale for design, and a systematic approach to development and evaluation. Descriptive research efforts should inform this process, focusing on homogeneity in sample, identification of risk factors for complicated grief and the impact of extraneous factors on intervention effects. Interventions should include comparisons to usual care, as well as replication to confirm positive findings.