scholarly journals A qualitative study investigating Australian cancer service outpatients’ experience of distress screening and management: what is the personal relevance, acceptability and improvement opportunities from patient perspectives?

2021 ◽  
Author(s):  
Kristen McCarter ◽  
Melissa A. Carlson ◽  
Amanda L. Baker ◽  
Chris L. Paul ◽  
James Lynam ◽  
...  
Keyword(s):  
Supportive Care ◽  
Psychosocial Support ◽  
Well Being ◽  
Structured Interview ◽  
Support Networks ◽  
External Support ◽  
Cancer Center ◽  
Distress Screening ◽  
Screening Process ◽  
Qualitative Interview Study

Abstract Purpose People diagnosed with cancer experience high distress levels throughout diagnosis, treatment, and survivorship. Untreated distress is associated with poor outcomes, including worsened quality of life and higher mortality rates. Distress screening facilitates need-based access to supportive care which can optimize patient outcomes. This qualitative interview study explored outpatients’ perceptions of a distress screening process implemented in an Australian cancer center. Methods Adult, English-speaking cancer outpatients were approached to participate in face-to-face or phone interviews after being screened by a clinic nurse using the distress thermometer (DT). The piloted semi-structured interview guide explored perceptions of the distress screening and management process, overall well-being, psychosocial support networks, and improvement opportunities for distress processes. Thematic analysis was used. Results Four key themes were identified in the 19 interviews conducted. Distress screening was found to be generally acceptable to participants and could be conducted by a variety of health professionals at varied time points. However, some participants found “distress” to be an ambiguous term. Despite many participants experiencing clinical distress (i.e., DT ≥ 4), few actioned referrals; some noted a preference to manage and prevent distress through informal support and well-being activities. Participants’ diverse coping styles, such as positivity, acceptance, and distancing, also factored into the perceived value of screening and referrals. Conclusion and implications Screening models only measuring severity of distress may not be sufficient to direct care referrals, as they do not consider patients’ varying coping strategies, external support networks, understanding of distress terminology, and motivations for accessing supportive care services.

Comprehensive distress screening and referral at a tertiary cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 134-134
Author(s):  
Elizabeth Trice Loggers ◽  
Stephen Duane Watkins King ◽  
Jesse R Fann ◽  
Kerry K McMillin ◽  
Jodie HN David ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Well Being ◽  
Cancer Center ◽  
Screening Methods ◽  
Distress Screening ◽  
Web Based ◽  
Care Services ◽  
Existential Crisis ◽  
Patient Health ◽  
English Speaking

134 Background: Addressing distress in cancer patients is now broadly recognized as critical to well-being and associated with increased survival. Cancer centers are developing innovative distress screening methods; we describe our novel process and results. Methods: New patients from 9/2015 to 3/2017 received an email requesting completion of a 44-item web-based survey assessing depression (2-item Patient Health Questionnaire), anxiety (2-item Generalized Anxiety Disorder), quality of life (QOL, 28-item Functional Assessment of Cancer Treatment-General), malnutrition (3-item Malnutrition Screening Tool), and 9 items addressing existential crisis, physical function, symptoms, tangible needs and concerns for dependent children. Results were computer scored, with positive screens resulting in direct, automated referrals to supportive care services (SCR). Analysis includes descriptive statistics and logistic regression using SAS 9.4. Results: 71% (n = 2629 of 3724) of those approached provided an email and completed the survey; 73% reporting no survey burden. Non-responders were more likely to be minority, non-English speaking, with non-commercial insurance (all p < 0.001). 59% (n = 1543) of responders screened positive for one or more SCR, including 6% to palliative care for poor QOL or symptoms. Receipt of SCR was more likely with Medicaid insurance (1.36 odds ratio [OR], 95% confidence interval [CI] 1.06-1.76, p = .0061); plan to receive care (1.27 OR, CI 1.07-1.50, p = .0061); and any report of survey burden (2.26 OR, CI 1.83-2.80, p < .0001). Conclusions: Web-based distress screening is feasible, efficient and not burdensome for the majority of cancer patients. Those who find this screening burdensome are two-fold more likely to have distress. Future efforts should address screening of vulnerable populations.

scholarly journals Being active 1½ years after hip fracture: A qualitative interview study of aged adults’ experiences of meaningfulness

2020 ◽  
Author(s):  
Birgit Rasmussen ◽  
Claus Vinther Nielsen ◽  
Lisbeth Uhrenfeldt
Keyword(s):  
Hip Fracture ◽  
Life Experience ◽  
Well Being ◽  
Structured Interview ◽  
Main Theme ◽  
Individual Interviews ◽  
Self Confidence ◽  
Existential Theory ◽  
Qualitative Interview Study ◽  
Interview Guide

Abstract Background: Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF. Methods: A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied. Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes. Results: Two main themes emerged. The main-theme “Feeling the continuity of life“ had four sub-themes: “Gratitude for present possibilities,“ “Connected with earlier life-experience,“ “Thoughtfully managing vulnerability,“ and “Belonging with other people.“ The main-theme “Feeling vulnerable“ had two sub-themes: “Thwarted“ and “Sad and regretting lost continuity in life.“ Conclusions: Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.

Problem areas identified by cancer patients with a positive distress screen in the medical clinic.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Teresa L. Deshields ◽  
Mary Jane Ruhland
Keyword(s):  
Medical Record ◽  
Rating Scale ◽  
Gynecologic Oncology ◽  
Screening Method ◽  
Well Being ◽  
Problem Area ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Problem List ◽  
Distress Screening

63 Background: NCCN has been advocating for distress screening since the inaugural Distress Management Guidelines in 1999. ASCO’s Quality Oncology Practice Initiative incorporated an indicator of patients’ emotional well-being in 2009. The ACoS Commission on Cancer established mandatory distress screening as an accreditation requirement for cancer programs in January 2015. This latter requirement dramatically increased the number of cancer programs doing routine distress screening. We examined distress screening results at a comprehensive cancer center. Methods: Results of distress screening were reviewed in the following clinical areas: medical oncology, radiation oncology, gynecologic oncology, and otolaryngology. Distress screening was completed verbally as a part of the vitals assessment, using the NCCN Distress Thermometer and Problem List. Only patients with a positive screen ( < 6 on 0-10 rating scale) completed the Problem List, identifying relevant problem areas (Emotional, Family, Practical, Physical, Spiritual and Other). The MA or RN doing the distress screening entered the distress rating and the endorsed problem area(s) in the electronic medical record. Results: In the first 5 months of 2017, 11,155 screening results were entered into the medical record. The percent of positive screens ranged from 5.7 to 8.6%, with X = 6.6% of screens being positive for distress. The most common problem areas were Emotional, endorsed with X = 72.5% of positive screens (range = 33.5-96.6%); Physical, endorsed with X = 67.52% of positive screens (range = 42.8-86.4%); and Practical, endorsed with X = 43.1% of positive screens (range = 20.1-59.9%). Conclusions: While some cancer centers use a psychologically-focused screening method (e.g. PHQ-9, BDI), distress is a bio-psychosocial construct, which requires a screening method that includes multiple domains. Furthermore, the triage related to distress screening may best be accomplished by the cancer team at the clinic visit, so that physical problems can be further assessed and addressed during the visit. The medical team can also make referrals to social work or psychological services to address related problem areas, when identified by patients.

Distress screening through PROMIS at an academic cancer center and network site: Implementation of a hybrid model.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2021-2021
Author(s):  
Mohana Roy ◽  
Joel W. Neal ◽  
Kelly Bugos ◽  
Christopher Sharp ◽  
Patricia Falconer ◽  
...  
Keyword(s):  
Supportive Care ◽  
Screening Tool ◽  
Cancer Center ◽  
Patient Portal ◽  
Supportive Services ◽  
Distress Screening ◽  
Positive Screen ◽  
Network Site ◽  
Care Services ◽  
Patient Reported

2021 Background: The NCCN guidelines recommend routine distress screening of patients with cancer, but the implementation of such programs is inconsistent. Up to one in three such patients experience distress, however fewer than half of them are identified and referred for supportive services. Methods: We implemented a hybrid (electronic and paper) distress screening tool, using a modified version of the PROMIS-Global Health questionnaire. Patients received either an electronic or in-clinic paper questionnaire to assess overall health and distress at the Stanford Cancer Center and its associated integrated network site. Iterative changes were made including integration with the electronic health record (EHR) to trigger questionnaires for appointments every 60 days. A consensus “positive screen” threshold was defined, with data collected on responses and subsequent referrals placed to a supportive care services platform. Results: Between June 2015 and December 2017, 53,954 unique questionnaires representing 12,744 distinct patients were collected, with an average completion rate of 58%. Approximately 30% of the questionnaires were completed prior to the visit electronically through a patient portal. The number of patients meeting the positive screen threshold remained ~ 40% throughout this period. Following assessment by the clinical team, there were 3763 referrals to cancer supportive services. Among the six most common referral categories, those with a positive screen were more likely to have a referral placed (OR 6.4, 95% CI 5.8-6.9 p- < 0.0001), with a sensitivity of 80% and a specificity of 61%. However, 89% of responses with a positive screen did not have a referral to supportive care services. Conclusions: The hybrid electronic and paper use of a commonly available patient reported outcome tool, as a high throughput distress screening tool, is feasible at a multi-site academic cancer center. Our positive screen rate for referrals was sensitive and consistent, but with a low positive predictive value. This screening also resulted in variable clinical response and overall increased clinical burden. Future directions for our group have included refining the threshold for a positive screen and implementation of a real-time response system, especially to address acute concerns.

Development, implementation, and initial results of the UC San Diego Health Moores Cancer Center Wellbeing Screening Tool

2019 ◽  
Vol 17 (04) ◽  
pp. 431-435
Author(s):  
Veronica Cardenas ◽  
Yuko Abbott ◽  
Jeremy M. Hirst ◽  
Brent T. Mausbach ◽  
Suzanne Agarwal ◽  
...  
Keyword(s):  
Program Implementation ◽  
San Diego ◽  
Screening Tool ◽  
Screening Program ◽  
Electronic Medical Record System ◽  
Cancer Center ◽  
Successful Implementation ◽  
Distress Screening ◽  
Record System ◽  
Screening Process

AbstractObjectiveAll accredited cancer institutions are required to screen patients for psychosocial distress. This paper describes the development, implementation, and preliminary outcomes of the University of California San Diego Health Moores Cancer Center Wellbeing Screening Program.MethodEssential steps learned in a formal National Cancer Institute–funded training workshop entitled “Implementing Comprehensive Biopsychosocial Screening” were followed to ensure successful program implementation. These steps included identification of stakeholders; formation of a working committee; establishment of a vision, process, and implementation timeline; creation of a screening tool; development of patient educational material; tool integration into an electronic medical record system; staff training and pilot testing of tool administration; and education about tool results and appropriate follow-up actions. Screening data were collected and analyzed retrospectively for preliminary results and rapid cycle improvement of the wellbeing screening process.ResultsOver an 8-month implementation and assessment period, the screening tool was administered 5,610 times of 7,664 expected administrations (73.2%.) to 2,394 unique patients. Visits in which the questionnaire was administered averaged 39.6 ± 14.8 minutes, compared with 40.3 ± 15.2 minutes for visits in which the questionnaire was not administered (t = −1.76, df = 7,662, p = 0.079).Significance of resultsThis program provides a process and a tool for successful implementation of distress screening in cancer centers, in a meaningful way for patients and providers, while meeting accreditation standards. Further, meaningful data about patient distress and tool performance were able to be collected and utilized.

Family experiences of oncological palliative and supportive care in children: can we do better?

2019 ◽  
Vol 25 (9) ◽  
pp. 421-430
Author(s):  
Jan Plessis ◽  
David Stones ◽  
Michelle Meiring
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
Healthcare Professionals ◽  
Psychosocial Support ◽  
Family Members ◽  
Hospital Setting ◽  
Structured Interview ◽  
Theory Approach ◽  
Children With Cancer ◽  
Care Services

Aims: Families were interviewed as a quality improvement assessment for palliative and supportive care services for children. Methods: This exploratory qualitative study of family members of children with cancer was conducted at an academic hospital in central South Africa and a grounded theory approach was used. Face-to-face interviews using a semi-structured interview guide were conducted with 16 family members of 16 children. Findings: Parents felt supported by the healthcare professionals who were caring for their child, but several shortcomings were identified. These included erratic psychosocial support, minimal financial support and poor parental access to basic needs and food provision, preventable errors in procedures and a lack of support available for siblings. It is also worth noting that healthcare professionals did not always seem sufficiently equipped to attend to palliative care patients. Conclusion: Strategies to improve supportive and palliative care are needed for children with cancer and their families in a hospital setting. The interviews identified a number of themes and current shortcomings that should be considered to improve services.

The impact of early integrated supportive care on length of stay at an NCI-designated cancer center.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2024-2024
Author(s):  
Jessica Kaltman ◽  
Can-Lan Sun ◽  
Matthew J. Loscalzo ◽  
Erik Kronstadt ◽  
Elizabeth Goodspeed ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Supportive Care ◽  
Hematologic Malignancy ◽  
Child Life ◽  
Cancer Center ◽  
Care Model ◽  
Distress Screening ◽  
Oncology Patients ◽  
Value Based Care ◽  
The Impact

2024 Background: With movement towards value-based care, institutions seek ways to reduce costs by decreasing inpatient stays. A multidisciplinary approach to supportive care, especially when provided early, is one way to realize value-based care. We assess the impact of pre-admission versus post-admission involvement of an Integrated Supportive Care Model (ICSM) on inpatient length of stay (LOS) at a NCI-designated cancer center. Methods: Data was collected from 2014 to 2016 at City of Hope. The Integrated Supportive Care Model at City of Hope includes: palliative care, psychiatry, psychology, interventional pain, social work, child-life, distress screening, and couples program. “Pre-admission” was defined as seeing at least one service prior to hospital admission; “Post-admission” defined as seeing at least one service during admission. “Short LOS” for hematology patients was categorized as ≤ 14 days and for oncology patients as ≤ 3 days. Continuous LOS between patients receiving an ISCM intervention pre- and post-admission was compared using Kruskal-Wallis test. Univariate and multivariable logistic regression was done to examine association between involvement of ISCM pre- and post-admission and categorical LOS. P-values < 0.05 were considered statistically significant. Results: 1,627 (809 with hematologic malignancy, 818 with oncologic malignancy) patients with only one hospitalization during the study time were included. For hematology patients, involvement with the ISCM pre-admission was associated with shorter LOS ( ≤ 14 days) compared with involvement post-admission (29.3 vs 11.1%, multivariable OR = 4.08, P < 0.001). Median LOS for hematology patients who participated in the ISCM pre-admission was shorter than those who received ISCM services post-admission (21 vs. 22 days, p = 0.049). Similarly, for oncology patients, ISCM involvement pre-admission was associated with shorter LOS ( ≤ 3 days) compared to involvement post-admission (91.4% vs 8.6%, multivariable OR = 3.74, P < 0.001). Median LOS for oncology patients who received an ISCM intervention pre-admission was shorter than those who received an ISCM intervention post-admission (2 vs. 6 days, p < 0.001). Conclusions: In hematologic and oncologic malignancies, use of an ISCM prior to patient’s first hospitalization is associated with significantly shorter LOS compared with those who received ISCM services during the hospital stay. This suggests efforts should be made to include an ISCM early in the trajectory of illness, prior to first hospitalization.

Voices of Distress: The Emotional Peril of Not Attaining a Dietetic Internship in Ontario

2013 ◽  
Vol 1 (3) ◽  
pp. 9
Author(s):  
Jennifer Lee Brady ◽  
Annie Hoang ◽  
Olivia Siswanto ◽  
Jordana Riesel ◽  
Jacqui Gingras
Keyword(s):  
Empirical Research ◽  
Current Model ◽  
Well Being ◽  
Structured Interview ◽  
Application Process ◽  
Dietetic Education ◽  
Dietetic Internship ◽  
The Impact ◽  
And Training ◽  
Future Growth

Obtaining dietetic licensure in Ontario requires completion of a Dietitians of Canada (DC) accredited four-year undergraduate degree in nutrition and an accredited post-graduate internship or combined Master’s degree program. Given the scarcity of internship positions in Ontario, each year approximately two-thirds of the eligible applicants who apply do not receive a position XX, XX, XX, XX, XX, XX, in press). Anecdotally, not securing an internship position is known to be a particularly disconcerting experience that has significant consequences for individuals’ personal, financial, and professional well-being. However, no known empirical research has yet explored students’ experiences of being unsuccessful in applying for internship positions. Fifteen individuals who applied between 2005 and 2009 to an Ontario-based dietetic internship program, but were unsuccessful at least once, participated in a one-on-one semi-structured interview. Findings reveal that participants’ experiences unfold successively in four phases that are characterized by increasingly heightened emotional peril: naïveté, competition, devastation, and frustration. The authors conclude that the current model of dietetic education and training in Ontario causes lasting distress to students and hinders the future growth and vitality of the dietetic profession. Further research is required to understand the impact of the current model on dietetic educators, internship coordinators, and preceptors as coincident participants in the internship application process.

Feasibility study of technology-enabled prevention intervention for children and families (Preprint)

2019 ◽  
Author(s):  
Nikki Theofanopoulou ◽  
Katherine Isbister ◽  
Julian Edbrooke-Childs ◽  
Petr Slovák
Keyword(s):  
Emotion Regulation ◽  
Pilot Study ◽  
Low Cost ◽  
Digital Camera ◽  
Well Being ◽  
Structured Interview ◽  
Object A ◽  
Intervention Delivery ◽  
Parents And Children

BACKGROUND A common challenge within psychiatry and prevention science more broadly is the lack of effective, engaging, and scale-able mechanisms to deliver psycho-social interventions for children, especially beyond in-person therapeutic or school-based contexts. Although digital technology has the potential to address these issues, existing research on technology-enabled interventions for families remains limited. OBJECTIVE The aim of this pilot study was to examine the feasibility of in-situ deployments of a low-cost, bespoke prototype, which has been designed to support children’s in-the-moment emotion regulation efforts. This prototype instantiates a novel intervention model that aims to address the existing limitations by delivering the intervention through an interactive object (a ‘smart toy’) sent home with the child, without any prior training necessary for either the child or their carer. This pilot study examined (i) engagement and acceptability of the device in the homes during 1 week deployments; and (ii) qualitative indicators of emotion regulation effects, as reported by parents and children. METHODS In this qualitative study, ten families (altogether 11 children aged 6-10 years) were recruited from three under-privileged communities in the UK. The RA visited participants in their homes to give children the ‘smart toy’ and conduct a semi-structured interview with at least one parent from each family. Children were given the prototype, a discovery book, and a simple digital camera to keep at home for 7-8 days, after which we interviewed each child and their parent about their experience. Thematic analysis guided the identification and organisation of common themes and patterns across the dataset. In addition, the prototypes automatically logged every interaction with the toy throughout the week-long deployments. RESULTS Across all 10 families, parents and children reported that the ‘smart toy’ was incorporated into children’s emotion regulation practices and engaged with naturally in moments children wanted to relax or calm down. Data suggests that children interacted with the toy throughout the duration of the deployment, found the experience enjoyable, and all requested to keep the toy longer. Child emotional connection to the toy—caring for its ‘well-being’—appears to have driven this strong engagement. Parents reported satisfaction with and acceptability of the toy. CONCLUSIONS This is the first known study investigation of the use of object-enabled intervention delivery to support emotion regulation in-situ. The strong engagement and qualitative indications of effects are promising – children were able to use the prototype without any training and incorporated it into their emotion regulation practices during daily challenges. Future work is needed to extend this indicative data with efficacy studies examining the psychological efficacy of the proposed intervention. More broadly, our findings suggest the potential of a technology-enabled shift in how prevention interventions are designed and delivered: empowering children and parents through ‘child-led, situated interventions’, where participants learn through actionable support directly within family life, as opposed to didactic in-person workshops and a subsequent skills application.

scholarly journals COVID-19 Pandemic and Helsinki University Hospital Personnel Psychological Well-Being: Six-Month Follow-Up Results

2021 ◽  
Vol 18 (5) ◽  
pp. 2524
Author(s):  
Tanja Laukkala ◽  
Jaana Suvisaari ◽  
Tom Rosenström ◽  
Eero Pukkala ◽  
Kristiina Junttila ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Psychosocial Support ◽  
Well Being ◽  
Incidence Rates ◽  
University Hospital ◽  
Hospital Personnel ◽  
Front Line ◽  
Hospital District ◽  
Variation Explained

The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. The psychological distress of the Helsinki University Hospital personnel has been followed via an electronic survey monthly since June 2020. We report six-month follow-up results of a prospective 18-month cohort study. Individual variation explained much more of the total variance in psychological distress (68.5%, 95% CI 65.2–71.9%) and negative changes in sleep (75.6%, 95% CI 72.2–79.2%) than the study survey wave (1.6%, CI 0.5–5.5%; and 0.3%, CI 0.1–1.2%). Regional COVID-19 incidence rates correlated with the personnel’s psychological distress. In adjusted multilevel generalized linear multiple regression models, potentially traumatic COVID-19 pandemic-related events (OR 6.54, 95% CI 5.00–8.56) and front-line COVID-19 work (OR 1.81, 95% CI 1.37–2.39) was associated with personnel psychological distress but age and gender was not. While vaccinations have been initiated, creating hope, continuous follow-up and psychosocial support is still needed for all hospital personnel.

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