The Commission on Cancer Psychosocial Distress Screening Standard: The first year in review.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 198-198 ◽  
Author(s):  
Nina S. Miller ◽  
Ryan M. McCabe ◽  
Allison Knutson
Keyword(s):  
Cancer Patients ◽  
Treatment Plan ◽  
Psychosocial Care ◽  
Psychosocial Distress ◽  
Screening Tools ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Centered ◽  
Screening Process ◽  
Cancer Program

198 Background: In response to recommendations from the 2007 Institute of Medicine report, Cancer Care for the Whole Patient, the American College of Surgeons’ Commission on Cancer developed a set of Continuum of Care standards, including a patient-centered standard regarding the delivery of psychosocial distress screening to all cancer patients. According to Cancer Program Standards 2012: Ensuring Patient-Centered Care, the accredited cancer program must implement a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care. Patients experience psychological, social, financial, and behavioral issues that can interfere with their treatment plan and adversely affect outcomes. Screening processes result in the identification of distressed cancer patients and assessment and referral pathways to ensure appropriate psychosocial care provision can be obtained. The standard was established in 2012 with a 2015 implementation period allowing programs time to develop a screening, assessment, and referral process tailored to their patient population. Methods: Programs submit documentation to describe their process for delivery of care through an electronic activity report. Documentation of this standard includes the timing for delivery of the psychosocial distress screening tool; methodology; the specific tools selected with preference to validated and reliable screening tools; and a process for assessment, referral and documentation. This presentation will summarize the program submissions for 2015 and include an analysis of the details of the standard compliance as reported by accredited programs. Results: This analysis will include responses from all Commission on Cancer accredited programs reporting on this standard. The analysis will provide information about the trends in the timing, methods, and tools used by programs implementing a psychosocial distress screening process. Conclusions: This analysis will inform future decisions about standardization of a screening process and the feasibility of pooling data across centers.

Psychosocial distress screening in cancer care.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 187-187 ◽  
Author(s):  
N Mullai
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Trigger Point ◽  
Emotional Experience ◽  
Psychosocial Care ◽  
Specific Area ◽  
Psychosocial Distress ◽  
Medical Visit ◽  
Distress Screening ◽  
Distress Level

187 Background: Distress is a multifactorial, emotional experience that may interfere with patients’ ability to cope with cancer and its treatment. Recognizing and managing distress may benefit patients. The Commission on Cancer requires implementation of Standard 3.2, Psychosocial Distress Screening in 2015 and integrating distress intervention in cancer care. This study evaluates patients’ perception on benefits in this regard. Methods: Patients were screened at least once at a pivotal medical visit using a questionnaire that included various aspects of stress. NCCN’s Psychosocial Distress Screening Tool was used to measure seriousness of distress. Patients marked their distress level on a scale of 1 to 10. A threshold of 5 was set as a trigger point to start addressing distress. Results: Answers from 311 cancer patients (male 61%; female 39%) were evaluated since January 2015. A majority of patients had breast cancer (29%), followed by lung (18%), GI (18%), and hematological (12%) malignancies. The mean distress score was 3.72 (male 3.14; female 3.97). 131 patients had a score above five. Age group, 40-49 years had a higher distress (4.79) compared to others. Esophageal cancer (1%) had the highest mean score 7.33 followed by head & neck cancer (4%) with 5.67. In most patients, anxiety about cancer and its treatment was the cause of distress. However, they did not want any additional psychosocial intervention except for talking to their oncologist and primary physician. The distress of some patients was family related and they were unsure of the help needed. Two patients refused screening stating the questions were intrusive. Conclusions: Coordinated psychosocial care may benefit cancer patients with significant distress. NCCN tool helps to assess the severity of patients’ distress and to determine the need for intervention. The results (mean score of 3.72) suggest most cancer patients need no major intervention or special psychosocial counseling other than discussing with their physician and family, which is done routinely in most oncology practices. However, when stress is expressed, this tool does help the treating physicians to determine the specific area and degree of stress, to focus on the type of help needed for the patient, and to channel resources appropriately.

The Commission on Cancer’s survivorship care plan standard: Implementation is underway.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 72-72
Author(s):  
Nina S. Miller
Keyword(s):  
Cancer Patients ◽  
Patient Centered Care ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Psychosocial Needs ◽  
Patient Centered ◽  
Cancer Program ◽  
Centered Care

72 Background: The American College of Surgeons Commission on Cancer established a patient-centered standard regarding the delivery of a survivorship care plan to cancer patients. In response to recommendations from the 2006 National Academy of Sciences, Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition, a working group developed a set of Continuum of Care standards to address the psychosocial needs of cancer patients. In 2009 Commission on Cancer members had met to discuss a strategic plan for addressing a major shift in accreditation standards from process to patient-centered care with a focus on patient outcomes. According to Cancer Program Standards: Ensuring Patient-Centered Care, the cancer program must implement a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. Programs are in full implementation mode and surveys monitoring this Survivorship Care Plan Standard have begun this year. The care plan provides guidance and recommendations for survivors and their healthcare providers to address the medical and psychosocial problems that may arise post-treatment. By delivering a plan, the patient is empowered with information about the treatment they have received, the recommendations for their care going forward, and recommended resources. Methods: Programs submit documentation to describe their process for delivery of care through an electronic activity report. Documentation of this standard includes method of delivery, identification of eligible patients, implementation process and tracking. This presentation will summarize program submissions for 2015-2016 and include an analysis of the details of the standard compliance as reported by accredited programs. Results: This analysis will include responses from all Commission on Cancer accredited programs reporting on this standard. The analysis will provide information about the trends in program implementation and compliance with the standard. Conclusions: This analysis will inform future decisions about the content of plans, the value of plan delivery to the provider and to the patient and summarize current practice.

Distress management in a community oncology center.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 107-107
Author(s):  
Lori Watts ◽  
Nicolas Camilo ◽  
Nicole Thurston ◽  
Michele Betts ◽  
Dan Sayam Zuckerman
Keyword(s):  
Social Workers ◽  
Cancer Patients ◽  
Nurse Practitioners ◽  
Sleep Problems ◽  
Psychosocial Care ◽  
Screening Tools ◽  
Distress Screening ◽  
Medical Provider ◽  
Care Clinic

107 Background: NCCN and the Institute of Medicine recommend distress screening for all cancer patients. Surveys have found that 20% to 47% of newly diagnosed and recurrent cancer patients experience significant levels of distress. Less than half of distressed patients with cancer are actually identified and referred for psychosocial help. The development of screening tools, processes, appropriate timing, and systems for follow up on concerns is an ongoing challenge for many cancer programs. Mountain States Tumor Institute p,iloted a distress screen process as part of our work with NCCCP. Methods: From October 24, 2011, to April 30, 2012, 133 patients completed distress screens. Most frequently reported concerns included fatigue (50%), sleep changes (32%), and anxiety/worry (31%). 51% of patients reported three or more concerns. 90% of all patients reporting anxiety also reported fatigue or sleep problems. All patients who reported concerns were offered social work and other supports. Screens were reviewed by social workers and discussed at weekly multidisciplinary psychosocial care rounds by social workers, psychiatrist, nurse practitioners, and chaplains. A variety of interventions were used to respond to distress including symptom management, education and referrals to on-site social workers, chaplains, supportive care clinic, integrative medicine and psychiatry. Results: A task was created in Mosaiq Electronic Medical Record to cue Health Information Specialists to schedule patients for distress screening as close as possible to 45 days from first chemotherapy treatment. Patients completed screens before seeing their medical provider. The majority of patients screened received one or more interventions in follow-up. Conclusions: EMRs can be effective tools to cue scheduled screening of patient distress. The use of multidisciplinary psychosocial care rounds can effectively help clinics plan interventions to alleviate patient distress. The use of rounds can ensure staff from different disciplines are not duplicating efforts and can help determine appropriate timing of various psychosocial interventions. Project funded with Federal funds from the NCI, Contract No HHSN261200800001E.

Refining the use of an electronic medical record (EMR) to define and implement psychosocial distress screening and treatment.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 144-144
Author(s):  
Joel Marcus
Keyword(s):  
Cancer Patients ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Health Care Providers ◽  
Psychosocial Care ◽  
Psychosocial Health ◽  
Psychosocial Distress ◽  
Cancer Center ◽  
Care Providers ◽  
Distress Screening

144 Background: All cancer patients experience some level of distress associated with cancer and its treatment at all stages of the disease. Psychological and social problems created or exacerbated by cancer cause additional suffering, weaken adherence to prescribed treatments and threaten patients' return to health." Health care providers often tend to under estimate psychological distress. Screening and early identification of distress promote improved management of symptoms, which facilitates medical care. Psychosocial care must be integrated into the routine treatment of cancer patients, per the Institute of Medicine's 2008 report "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs." Methods: Developing operational standards for Distress Screening our cancer center both NCCN guideline, Commission on Cancer Standards. These operational standards integrated our Electronic Medical Record to create "best practice advisories" to alert the physician to the possible need for further evaluation of distress and the possible need for referral to Social Work staff or the on-site Psychologist. Results: Referrals to our on-site staff Psychologist at our main campus were monitored. 306 unique patients were referred to our staff psychologist for evaluation and treatment during the 2014 calendar year. In the first three quarters of the 2015 a total of 445 were made. Surgical oncology clinics (Head & Neck, Breast & Upper Gastro-Intestinal) made the majority of referrals. Conclusions: In accordance with published guidelines and accrediting standards our cancer center utilized our electronic medical record to increase our ability to identify psychosocial distress in our population.

Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program

2021 ◽  
Author(s):  
Eden R. Brauer ◽  
Stephanie Lazaro ◽  
Charlene L. Williams ◽  
David A. Rapkin ◽  
Amy B. Madnick ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Psychosocial Distress ◽  
Distress Screening ◽  
Cancer Program ◽  
Screening Protocol

Psychosocial outcomes and care utilization among rural and nonrural cancer patients.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 79-79
Author(s):  
Angela E Usher ◽  
Janice Bell ◽  
Laurel A Beckett ◽  
Jill G Joseph ◽  
Brad J. Zebrack ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cancer Patients ◽  
Rural Areas ◽  
Urban Areas ◽  
Psychosocial Care ◽  
Psychosocial Outcomes ◽  
Psychosocial Distress ◽  
Care Utilization ◽  
Lower Odds ◽  
Independent Effects

79 Background: Approximately 20% of people diagnosed with cancer in the U.S. travel from rural areas to urban cancer centers for treatment. Rural cancer patients face unique challenges which may contribute to greater psychosocial distress when compared to urban-dwelling patients. While up to half of all cancer patients screen positive for psychosocial distress, only 25-44% of distressed patients utilize psychosocial care. Patients from rural areas may face greater barriers to utilization of psychosocial care compared to patients from urban areas. To date, few studies have focused on these concerns. Methods: Three-years of data were collected from newly diagnosed patients screened between 2015 and 2017, including the Patient Health Questionnaire-2 and the NCCN Distress Thermometer (n = 4,865). Adjusted multi-variable logistic regression, chi-square, and negative binomial regression were used to assess relationships among psychosocial outcomes and care utilization, rurality, and distance to treatment in driving miles, controlling for socio-demographic and clinical covariates. Distance to treatment based on driving miles computed in ArcGIS v10.5. Stata v15 was used for all statistical analyses, significance set at ≤.05. Results: Higher odds of depressive symptoms were detected among people living in rural areas compared to urban areas. The odds of psychosocial distress were higher in patients from rural areas and further distances from treatment compared to local distance. Patients from rural areas had lower odds of psychosocial care utilization compared to patients in urban areas. Distance to treatment had independent effects, over and above rurality, for lower odds of psychosocial care utilization. Conclusions: Distance to treatment and rurality appear to be risk factors with independent effects on depressive symptoms and psychosocial distress and appear to be associated with lower odds of psychosocial care use among cancer patients with self-reported distress when compared to patients from urban and local areas. Findings support improved detection of and response to patient reported psychosocial outcomes, and further research designed to better understand the mechanisms underlying the reported associations.

Patient-reported distress screening outcomes in breast cancer.

2015 ◽  
Vol 33 (28_suppl) ◽  
pp. 79-79
Author(s):  
Bridget Smart ◽  
Laura Vallow ◽  
Laeticia Hollant ◽  
Megan Single ◽  
Katherine Gaines ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Ductal Carcinoma ◽  
Clinical Results ◽  
Psychosocial Distress ◽  
Breast Cancer Patients ◽  
Distress Screening ◽  
Breast Radiotherapy ◽  
Patient Reported ◽  
Patients Experience

79 Background: A significant percentage of cancer patients experience psychosocial distress with the highest prevalence observed in breast cancer patients. The importance of psychosocial distress screening and assessment in women with breast cancer has clearly been established. Patients in our clinic are screened for distress. The results were reviewed in an attempt to better understand the psychosocial distress of breast cancer patients undergoing radiotherapy. Methods: Patients treated curatively for breast cancer prospectively completed the 30 question patient reported distress (PRD) survey that also included a linear analog measure of overall distress. The recorded clinical results of the PRD survey were retrospectively assessed in patients receiving breast radiotherapy from June 1, 2013 to February 2, 2015. Results: Completed PRD questionnaires were available on 179 female patients. 21 (12%) were treated for ductal carcinoma in situ and 91 (51%), 35 (20%), and 32 (18%) were treated for invasive carcinoma Stages I, II, and III. 85 (47%) received chemotherapy. Overall distress ranged from 0 to 10, with a median value of 5. Mean distress scores per category ranged from a low of 1.25 to a high of 2.52. Top concerns in descending order of importance were: “How will I feel during treatment” (2.52), “Fatigue” (2.46), “Sleep difficulties” (2.32), “How will I feel about appearance related to treatment” (2.23), & “Pain that affects daily functioning” (2.19). Least distressing symptoms “Spirituality” (1.25), “Housing during treatment” (1.26), “Control of anger” (1.28), “End of life concerns” (1.32), & “Transportation” (1.34). Conclusions: Distress over tumor related issues ranked low among women’s concerns in comparison to distress related to the side effects of therapy concerning treatment related discomfort, fatigue, and changes in appearance, and anxiety. Pain was a significant concern, although in this group of patients receiving definitive, adjuvant or neoadjuvant therapy, this was likely related to treatment associated discomfort rather than from disease progression. These findings highlight the importance of careful patient education and communication of the expected symptoms and effects of therapy.

Implementation of distress screening for breast cancer patients.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 196-196
Author(s):  
Jill Bryant ◽  
Helen Colleen Silva ◽  
Greg Mapp ◽  
Daphne Terrell
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Screening Tool ◽  
Treatment Plan ◽  
Disease Process ◽  
Breast Cancer Patients ◽  
Distress Screening ◽  
Extreme Stress ◽  
Number Of Patients ◽  
Short Period

196 Background: Cancer is a complex disease process. Patients experience psychological, social, financial, and behavioral issues that can interfere with their treatment plan and adversely affect their outcomes. Distress should be measured as the 6th Vital Sign. Consequences of distress can cause deterioration of Quality of Life; produce higher levels of pain; longer rehabilitation; reduced adherence to treatment with less efficacy; and shorter survival expectancy. Methods: Problem exists with a lack of screening patients’ level of distress during breast cancer experience within their cancer care continuum. Goal was to improve the prevalence of distress screening of breast cancer patients from 0% to 50% within 3 months. Cause and effect analysis showed evidence of areas for improvement. Improvements and interventions included: education on stress and psychosocial assessment; developing a distress screening tool; and developing inclusion criteria for patient screening. Screenings were completed on first follow-up visit after diagnosis with continuation of assessment every three months for the first year. A distress screening tool with a thermometer illustration was provided to the patients for them to rate amount of distress experienced in the past week. Scoring was “0 = no distress to 10 = extreme stress.” The tool also included Yes/No questions. A value of 4 or greater on the thermometer or any question marked “Yes” on the questionnaire was considered a positive screen. Results: In addition to developing a tool, a template was implemented in the electronic medical record. Opportunities for assistance with distress were discovered based on patients’ responses where interventions and follow-ups with the patient were provided. Conclusions: A process was developed and implemented to integrate and monitor on-site psychosocial distress screening and referral for provision of psychosocial care. A small number of patients analyzed met criteria during a short period of time. The percentage of distress screenings completed improved from 0% to 92%. [Table: see text]

Using electronic medical record system to improve compliance with national guidelines for comprehensive distress screening in cancer patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 309-309
Author(s):  
Chintan Pandya ◽  
Sandra Sabatka ◽  
Michelle Kettinger ◽  
Alexander Alongi ◽  
Lauren M. Hamel ◽  
...  
Keyword(s):  
Social Work ◽  
Cancer Patients ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Psychosocial Care ◽  
Structured Data ◽  
National Guidelines ◽  
Distress Screening ◽  
Oncology Care

309 Background: Psychosocial distress screening (DS) and management is associated with improved quality of life and outcomes in cancer patients and is required for accreditation by the American College of Surgeons Commission on Cancer. Comprehensive distress screening (CDS) consists of routine distress screening, evaluation, referral to appropriate psychosocial services, and follow-up to ensure adequate care. Electronic medical record (EMR) systems can be leveraged to facilitate and document CDS as part of clinical care and to evaluate the CDS process as a quality standard. The aim of this study is to develop and implement an EMR-based tool to document and evaluate the CDS process as part of routine oncology care. Methods: An EMR-based tool with structured data fields is developed for social workers to document risk factors for distress, assessment, management plan including psychosocial service referrals, and time spent delivering care following DS using the NCCN distress thermometer (DT). Evaluation of CDS process is done in cancer patients who have documented psychosocial care in the EMR-system from 1/2017-5/2018. Results: During the study period, 1327 cancer patients underwent 2480 distress screening evaluations. The average distress score was 3.2 (median = 2) on the DT scale of 0-10, with 855 (64%), 326 (25%), and 146 (11%) patients reporting on average mild (0-3), moderate (4-6), and severe (7-10) distress respectively. 400/1327 (30%) patients accounted for 1177 documented social work contact/visits, of which financial (40%) and emotional (15%) were the most common concerns. 89% (1047) of the visits had follow-up plans and 77% of encounters resulted in referrals, of which financial support (26%) and pharmacy assistance (22%) were the most common referral services. The average time spent on each psychosocial care visit was reported to be 21 minutes. Conclusions: EMR-based forms with structured data fields can be used to document and promote improved adherence to national guidelines for CDS as part of routine oncology care by facilitating data collection. Such tools can be leveraged to capture relevant data on impact of CDS on social work resource utilization.

A national approach to improving adolescent and young adult (AYA) oncology psychosocial care: The development of AYA-specific psychosocial assessment and care tools

2013 ◽  
Vol 12 (3) ◽  
pp. 183-188 ◽  
Author(s):  
Susan Palmer ◽  
Pandora Patterson ◽  
Kate Thompson
Keyword(s):  
Young Adult ◽  
Cancer Patients ◽  
Best Practice ◽  
Psychosocial Care ◽  
Population Group ◽  
Screening Tools ◽  
Adolescent And Young Adult ◽  
Psychosocial Assessment ◽  
Care Plan ◽  
Age Group

AbstractObjective:Age-based screening tools and assessment measures are crucial to the provision of best practice care for adolescent and young adult (AYA) cancer patients. Unfortunately, there are limited psychosocial tools developed for this age group and pediatric or adult measures are often distributed with the assumption that they are “close enough.” We describe a collaborative Australian project that strives to improve what currently exists for the psychosocial assessment of and planning for the 15–25-year-old age group.Method:Using the National Comprehensive Cancer Network's Distress Thermometer and the HEADSS Assessment as a foundation, the tools were developed in consultation with Australia's leading AYA clinicians, AYAs currently undergoing medical treatment, and a group of AYA survivors through a process of discussion groups and clinical interviews.Results:The result is the first available AYA-specific screening tool, care plan pro forma, and psychosocial assessment measure developed for use within the oncology sector. These new tools will assist clinicians working with this population group to support psychosocial coping during active treatment and promote healthy post-treatment survivorship.Significance of results:Over time, further validation procedures will add to the veracity of the measures. Until then, these measures represent the best available in Australia. They highlight a clinically recognized minimum standard of care that all young cancer patients, regardless of treatment location, have the right to receive.

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