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

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.

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Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life.

Journal of Clinical Oncology ◽

10.1200/jco.1996.14.10.2747 ◽

1996 ◽

Vol 14 (10) ◽

pp. 2747-2755 ◽

Cited By ~ 77

Author(s):

E Maunsell ◽

J Brisson ◽

L Deschênes ◽

N Frasure-Smith

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Psychosocial Intervention ◽

Initial Treatment ◽

Screening Program ◽

Group Differences ◽

Cancer Center ◽

Distress Screening ◽

Psychologic Distress

PURPOSE Although psychosocial intervention can reduce psychosocial distress following breast cancer, many women who are experiencing problems are not identified and offered additional help. This trial assessed effects on quality of life of psychologic distress screening among newly diagnosed, nonmetastatic breast cancer patients. PATIENTS AND METHODS From 1990 to 1992, all eligible patients in one regional breast cancer center were identified and offered study participation. Women in both control and experimental groups received brief psychosocial intervention from a social worker at initial treatment. The experimental group also had monthly telephone screening of distress levels using a brief, validated instrument, with additional psychosocial intervention offered only to those with high distress at screening. RESULTS Among 282 eligible patients, 89% were randomized and completed the study. Participants' psychologic distress levels decreased over the study period (P = .0001). However, no between-group differences were observed. Mean distress scores among control and experimental women at 0-, 3-, and 12-month interviews were 20.7 and 20.4, 15.5 and 15.0, and 14.6 and 13.5, respectively. No between-group differences were observed with respect to physical health, functional status, social and leisure activities, return to work, or marital satisfaction. CONCLUSION Our results indicate that, among patients who receive a minimal psychosocial intervention as part of their initial cancer care, a distress screening program does not improve quality of life. Minimal psychosocial intervention at initial treatment may be effective in reducing distress, thus making it difficult to obtain additional benefit from a screening program.

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Barriers and facilitators to implementing the commission on cancer's distress screening program standard

Palliative & Supportive Care ◽

10.1017/s1478951518000378 ◽

2018 ◽

Vol 17 (03) ◽

pp. 253-261 ◽

Cited By ~ 5

Author(s):

Andrea K. Knies ◽

Devika R. Jutagir ◽

Elizabeth Ercolano ◽

Nicholas Pasacreta ◽

Mark Lazenby ◽

...

Keyword(s):

Mixed Methods ◽

Training Programs ◽

Screening Program ◽

Goal Achievement ◽

Barriers And Facilitators ◽

Distress Screening ◽

Institutional Barriers ◽

Institutional Factor ◽

Achievement Data ◽

American College Of Surgeons

AbstractObjectiveMany cancer centers struggle to implement standardized distress screening despite the American College of Surgeons’ Commission on Cancer 2012 mandate for a distress screening program standard of care by 2015. This paper presents outcomes for the first cohort of participants (n= 36) of a Screening for Psychosocial Distress Program (SPDP), a 2-year training program designed to assist clinicians in implementing routine distress screening as mandated by the American College of Surgeons Commission on Cancer. Specifically, participants’ success with distress screening implementation, institutional barriers and facilitators to implementation, and the role of the SPDP are described.MethodThis research followed a longitudinal pre- and posttest mixed methods design. An investigator-developed questionnaire collected qualitative (distress screening goals, institutional barriers and facilitators, facilitators associated with participation in the SPDP) and quantitative (level of goal achievement) data at 6, 12, and 24 months of participation in the SPDP. Conventional content analysis was applied to qualitative data. Mixed methods data analysis in Dedoose evaluated (1) types and number of distress screening goals, barriers, and facilitators, and (2) goal achievement at 6, 12, and 24 months of participation.ResultNinety-five percent of distress screening implementation goals were completed after 2 years of participation. Most common institutional barriers to distress screening implementation were “lack of staff,” “competing demands,” and “staff turn-over.” Most common institutional facilitators were “buy-in,” “institutional support,” and “recognition of participants’ expertise.” The number of reported facilitators associated with SPDP participation was higher than the number associated with any institutional factor, and increased over time of participation.Significance of resultsParticipating in training programs to implement distress screening may facilitate successful achievement of the Commission on Cancer's distress screening standard, and benefits seem to increase with time of participation. Training programs are needed to promote facilitators and overcome barriers to distress screening.

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CancerSupportSource®: validation of a revised multi-dimensional distress screening program for cancer patients and survivors

Supportive Care in Cancer ◽

10.1007/s00520-019-04753-w ◽

2019 ◽

Vol 28 (1) ◽

pp. 55-64 ◽

Cited By ~ 3

Author(s):

Joanne S. Buzaglo ◽

Alexandra K. Zaleta ◽

Shauna McManus ◽

Mitch Golant ◽

Melissa F. Miller

Keyword(s):

Cancer Patients ◽

Screening Program ◽

Distress Screening

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Implementation of a community-based cervical cancer screening program using visual inspection with acetic acid and Lugol’s iodine in Kutch District, India.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e12009 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e12009-e12009

Author(s):

Surbhi Grover ◽

Melody Ju ◽

Lilie L. Lin ◽

Shobha Krishnan

Keyword(s):

Cervical Cancer ◽

Acetic Acid ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Visual Inspection ◽

Screening Program ◽

Cancer Center ◽

Community Based ◽

Screening Programs ◽

Lugol’S Iodine

e12009 Background: Visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) is increasingly reframed as a bridge modality through which low resource countries can provide cervical cancer screening while waiting for the more effective HPV DNA tests to become affordable. Often the screening programs are organized by government bodies that lack the trust of the local communities and hence such programs suffer from poor participation. Here we aim to describe a locally-sustained VIA/VILI screening program in rural Kutch district in India directed by Kutch Mahlia Vikas Sangathan (KMVS), a local NGO committed to women empowerment. Methods: All capacity-building measures (funding, training, materials, and healthcare workers) were rooted in the local community. Heath workers were sent to Tata Memorial Cancer Center in Mumbai for training. NGO members held information sessions prior the screening camps educating women about the significance of screening. A three-visit screening model using VIA/VILI was implemented. At first visit, all women were consented and screened. VIA/VILI positive women returned for a second visit for biospy. Biopsy positive women then returned for a third visit to arrange for treatment. All the screening camps were conducted in community buildings such as schools with the collaboration of the village leaders. Results: Screening camps were set up in 17 villages in 2010-2011, screening a total of 832 married women upto the age of 50. There were 0 cervical intraepithelial neoplasia (CIN) positive lesions or invasive cancers found. None of the women were lost to follow-up. Conclusions: It is feasible to develop a community level screening program and to provide cancer prevention needs from within a community. Future directions include further evaluation of downstream protocols after VIA/VILI tests, increasing health worker diagnostic and treatment capacity, and determining positive recruitment factors in women attending screening camps. The KMVS screening program has been well-received and has been approached by several other NGO’s and training centers seeking to build similar community-based cervical cancer screening programs.

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Psycho-oncology via telemedicine: A model to provide services to a rural population.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.236 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 236-236

Author(s):

Susan Krigel ◽

Eve-Lynn Nelson ◽

Ashley Spaulding ◽

Hope Krebill ◽

Melanie Leepers ◽

...

Keyword(s):

Lessons Learned ◽

Rural Site ◽

Cancer Center ◽

Medical Illness ◽

Psychosocial Needs ◽

Distress Screening ◽

Oncology Service ◽

Management Procedures ◽

Rural Sites ◽

Evidence Based Care

236 Background: The Midwest Cancer Alliance (MCA), the outreach arm of the University of Kansas Cancer Center, developed psycho-oncology services over videoconferencing in partnership with its rural members. The collaborative goal is to address patient-identified psychosocial needs that are not currently being met in the communities. Methods: Following telemental health best practices, MCA personnel, rural site leaders, local oncology and behavioral health teams, and telemedicine staff collaborated closely to establish the service. They developed detailed protocols related to: referral and scheduling; technical training and support; paperwork; videoconferencing sessions; post-visit follow-up/documentation; and emergency management procedures. Attention was given to: confidential space; equipment to meet therapy needs; the telemedicine coordinator’s role; and completion of professional requirements (e.g., licensing, credentialing, malpractice coverage). Results: Credentialing, site implementation, and patient recruitment took longer than anticipated. To date, 15 patient visits have occurred through the psycho-oncology service across two rural sites. Worsening illness has impacted referrals as well as retention in therapy. Videoconferencing services have approximated onsite psycho-oncology strategies, with focus on evidence-based care. In general, patients have had advanced medical illness as well as significant premorbid psychosocial difficulties, such as mood disorders, substance abuse history, and relationship problems. Basic challenges to care have remained, including lack of consistent transportation. The telepsychologist’s role in relation to the rural medical team expectations is still evolving. Conclusions: The early lessons learned will continue to strengthen the psycho-oncology service as videoconferencing services expand in order to increase access. Ongoing, site-specific needs assessment remains essential, as “one size does not fit all.” Future plans include improving recruitment by coordinating referrals with distress screening. In order to provide sites with maximum flexibility, new methods of communication will be offered as they become available.

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Pilot study assessing distressors affecting patients with cancer using the distress screening tool.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.68 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 68-68

Author(s):

Antoine Nafez Finianos ◽

Jeanny B. Aragon-Ching ◽

Ehab El Bahesh ◽

Richard Amdur ◽

Jenifer Bires ◽

...

Keyword(s):

Univariate Analysis ◽

Emotional Problems ◽

Problem Area ◽

Cancer Center ◽

Distress Screening ◽

Sample Mean ◽

Family Problems ◽

Care Services ◽

Number Of Patients ◽

Global Distress

68 Background: Distress is a non-stigmatic description of emotional, physical, spiritual or psychiatric stressors experienced by patients (pts) diagnosed with cancer. We sought to determine the prevalence of distress in different cancer population of pts seen in our cancer center as they are commencing chemotherapy. Methods: We retrospectively examined data using the Distress Thermometer (DT) based on the National Comprehensive Cancer Network (NCCN) and assessed a single encounter on 240 consecutive patients undergoing their first chemotherapy session. Univariate associations were examined between specific problems and overall distress levels with a 2-tailed between-group t-test. Problem area scores were computed for each subject by taking the mean number of problems rated positive within each area, and associations between each problem area score and distress was examined using Spearman correlations. Results: Among the 240 patients in the sample, mean age was 60 ± 14, 61% were female, and 82% had solid tumors. The overall mean distress, based on the DT reading, was 3.6 ± 3.0. Specific problems reported by the largest number of patients included worry (n = 85), nervousness (n = 79), fatigue (n = 70), sleep (n = 66), and fears (n = 57). Of these, all but fatigue were significantly associated with global distress in univariate analysis. When mean problems per area were calculated, and correlated with global distress, each problem area (practical, emotional, family, physical) had a significant univariate association with global distress, with emotional problems having the highest correlation (r = .52, p < .0001). The only predictors with significant independent associations to predict global distress in the general linear model were emotional problems (p = .0001) and family problems (p = .0062), independent of age, sex and tumor types. Conclusions: In cancer patients undergoing distress screening as they receive their first chemotherapy, emotional and family problems appear to have the highest correlation with distress. Improvement of supportive care services geared towards the betterment of these symptoms is of paramount importance in improving outcomes.

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Comprehensive distress screening and referral at a tertiary cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.134 ◽

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.

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Pragmatic randomized trial of a distress screening program using an effectiveness-implementation hybrid design.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.5 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 5-5

Author(s):

Erin Elizabeth Hahn ◽

Corrine E. Munoz-Plaza ◽

Dana Pounds ◽

Lindsay Joe Lyons ◽

Janet S. Lee ◽

...

Keyword(s):

Randomized Trial ◽

Screening Program ◽

Medical Center ◽

Qualitative Interviews ◽

Audit And Feedback ◽

Implementation Barriers ◽

Distress Screening ◽

Screening Programs ◽

Adaptive Workflow ◽

New Diagnosis

5 Background: Implementation of guideline-recommended distress screening in oncology remains challenging. Evidence suggests that multicomponent care pathways to identify distress severity with algorithm-based referral and management are effective, yet testing of pragmatic implementation in community settings remains limited. We conducted a pragmatic randomized trial of a distress screening program in a large healthcare system to evaluate effectiveness and simultaneously examined implementation outcomes. Methods: We designed a highly pragmatic study per the Pragmatic-Explanatory Continuum Indicator Summary-2 with adaptive workflow design. Randomization was at the medical center level (N=6); eligible patients had a new diagnosis of breast cancer (no exclusions). Eligible patients were offered the distress screening program as part of usual care: PHQ-9 screening, algorithm-based scoring and referral, referral tracking, and audit and feedback of performance data. Control sites had access to the PHQ-9 and scoring algorithm. We compared number screened, distress severity, and referral. We conducted qualitative interviews with stakeholders on implementation barriers and facilitators. Results: We enrolled 1,436 eligible patients; 692 control, 744 intervention. Groups were similar in demographic and tumor characteristics (Table); 80% of patients completed screening at intervention sites vs <1% at control sites. Of those screened at intervention sites, 10% scored in the medium/high range indicating need for referral; 94% received an appropriate referral. We conducted 20 interviews; the program was found to be highly feasible and acceptable. Conclusions: Our pragmatic, adaptive approach resulted in the large majority of patients screened and appropriately referred with a high degree of acceptability and feasibility. Our results can promote more widespread, sustained adoption of effective distress screening programs. Clinical trial information: NCT02941614. [Table: see text]

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