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.

Leveraging technology to facilitate distress screening.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 195-195
Author(s):  
Susan Franco ◽  
Dawn Jourdan
Keyword(s):  
Multidisciplinary Team ◽  
Screening Tool ◽  
Screening Program ◽  
Case Manager ◽  
Distress Screening ◽  
Screening Process ◽  
Distress Score ◽  
Increased Risk ◽  
Oncology Practice ◽  
The Individual

195 Background: Research has shown cancer patients are at increased risk for distress during their cancer treatment. Distress screening is required for cancer programs seeking accreditation from the American College of Surgeons, Commission on Cancer and certification from the American Society of Clinical Oncology Quality Oncology Practice Initiative. Developing a successful distress screening program is essential for cancer programs. Methods: The purpose of this project was to create a comprehensive distress screening program utilizing the electronic health record (EHR) to identify patients requiring screening and document interventions. A multidisciplinary team was established to develop a distress screening process for our cancer program. The team developed a screening tool based on the National Comprehensive Cancer Network Distress Thermometer. The distress screening tool was built into the EHR. An alert was created to notify staff at visit check-in to provide the distress screening tool. Once completed, the score and any areas of distress indicated by the patient are entered into the EHR by the medical assistant. When a score is documented, the nurse case manager (CM) receives a “Distress Score” alert when accessing the patient’s chart, indicating the need for nursing review. The CM reviews the score, assesses patient needs and documents any needed interventions or referrals. A specific score does not require a specific intervention, rather the CM is required to determine the needs of the individual patient and take appropriate action. Results: In 2015, 8069 patients were offered distress screening with 13,527 distress screenings completed. This resulted in 629 referrals to social work. 803 distress screens had a score of seven or greater (6%). Conclusions: The multidisciplinary team continues to evaluate the process and make changes. Auditing reveals compliance with documenting a distress score of 95% or greater across all oncology areas and review by the CM of at least 93% on a consistent basis. In many instances, the physician and/or the CM address distress related to the patient’s disease or symptom management. Use of the EHR has facilitated the workflow and allowed information to be visible to the care team.

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.

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.

Utilizing technology for malnutrition screening and referrals to nutrition services.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 284-284
Author(s):  
Susan Franco ◽  
Corrine Hanson ◽  
Glenda Woscyna ◽  
Jana Wells ◽  
Meghan McLarney
Keyword(s):  
Nursing Staff ◽  
Screening Tool ◽  
Screening Tools ◽  
Cancer Center ◽  
Oncology Patients ◽  
Record System ◽  
Nutrition Screening ◽  
Nutrition Risk ◽  
Positive Screen ◽  
Nutrition Services

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

Implementation of a distress screening program in a hospital-based cancer center

2010 ◽  
Author(s):  
Mary Kathryn Rodrigue ◽  
Sean Ransom ◽  
Courtney Dini ◽  
Lynda Thibodaux ◽  
Melissa Barrios ◽  
...  
Keyword(s):  
Screening Program ◽  
Cancer Center ◽  
Distress Screening

Cancer-related distress screening in a radiation oncology clinic: A snapshot view of a Veterans Administration (VA) institution screening program.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21562-e21562
Author(s):  
Timothy A. Lomauro ◽  
George Anthony Dawson ◽  
Lori Magda ◽  
Kristen Tobias ◽  
Maria D. Kelly
Keyword(s):  
Mental Health ◽  
Cancer Patients ◽  
Radiation Oncology ◽  
Treatment Guidelines ◽  
Screening Program ◽  
Standards Of Care ◽  
Health Clinic ◽  
Distress Screening ◽  
Screening Process ◽  
Treatment Population

e21562 Background: The emotional and psychosocial stress experienced by cancer patients are significant factors impacting cancer treatment outcomes and quality of life. Increased emphasis upon programmatic approaches to identifying distress has evolved to current evidenced-based treatment guidelines as reflected by American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have identified distress screening standards of care. This report is a snapshot of the results of a distress screening program in a VAMC Radiation Oncology clinic. Methods: Calendar year 2016 data was chosen for this quality improvement review. We wanted to assess the effectiveness of psychosocial distress screening process now routinely done in Radiation Oncology. Distress screening was completed utilizing the NCCN Distress Thermometer. The program’s goal was to administer distress screening to all patients at the time of their initial consultation and to follow up screening as appropriate. Results: The mean age of the patients was 68.6 years; 98% were male. The treatment population was 58% Caucasian, 38% African-American, 2% Hispanic, and 2% other. The most prevalent cancer diagnoses were: Prostate, 52%; Lung, 13.9%; Head & Neck Cancer, 7.2%, Skin, 4.6%; Esophageal or Gastric Cancer, 3.1%; Brain, 2.0%; and Breast, 2.0% Screenings were completed on 161 of 193 (83%) new consults in Radiation Oncology; 47.6% of patients screened scored at or above the established cut score of 4. Referrals to Oncology Psychology were initiated for 29.5% of total sample. Significant mental health co-morbidities were identified in the treatment population studied; 58.5% of patients had at least one mental disorder diagnosis. Examples: PTSD, Major Depressive Disorder, Substance Use Disorder, and Adjustment Disorder. Conclusions: Results reflect the usefulness of the distress screening process in identifying adjustment issues specific to cancer patients' experience, as well as exacerbations of existing mental health conditions. The screening process facilitated referral to specialty (Oncology Psychology) and general (Mental Health Clinic) services.

Implementation of Electronic Records in a Medical Practice Setting

2015 ◽  
pp. 96-106
Author(s):  
Jami M. Clark
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Center ◽  
Physical Space ◽  
Electronic Medical Record System ◽  
Care Practice ◽  
Successful Implementation ◽  
Record System ◽  
Positive Message ◽  
Medical Record System

Seneca Medical Center is a primary care practice that implemented an electronic medical record system in 2005. Since implementation, the practice has added different practice locations and its own lab. The implementation was smooth because the practice leadership had a positive message about the change and reasons for it. Physical space for housing charts of a growing practice, the drive toward quality, safety, efficiency, and future growth were factors that led to the transition to an electronic medical record system. Choosing a quality vendor, understanding the concerns and components involved, and excitement about change create an environment for a successful implementation.

Implementation of Electronic Records in a Medical Practice Setting

2014 ◽  
pp. 211-225
Author(s):  
Jami M. Clark
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Center ◽  
Physical Space ◽  
Electronic Medical Record System ◽  
Care Practice ◽  
Successful Implementation ◽  
Record System ◽  
Positive Message ◽  
Medical Record System

Seneca Medical Center is a primary care practice that implemented an electronic medical record system in 2005. Since implementation, the practice has added different practice locations and its own lab. The implementation was smooth because the practice leadership had a positive message about the change and reasons for it. Physical space for housing charts of a growing practice, the drive toward quality, safety, efficiency, and future growth were factors that led to the transition to an electronic medical record system. Choosing a quality vendor, understanding the concerns and components involved, and excitement about change create an environment for a successful implementation.

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