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.

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

2019 ◽  
Vol 28 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Joanne S. Buzaglo ◽  
Alexandra K. Zaleta ◽  
Shauna McManus ◽  
Mitch Golant ◽  
Melissa F. Miller
Keyword(s):  
Cancer Patients ◽  
Screening Program ◽  
Distress Screening

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.

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.

The Engaged Patient

2021 ◽  
pp. 393-399
Author(s):  
Mitch Golant ◽  
Alexandra K. Zaleta ◽  
Susan Ash-Lee ◽  
Joanne S. Buzaglo ◽  
Kevin Stein ◽  
...  
Keyword(s):  
Cancer Patients ◽  
New Technologies ◽  
Screening Program ◽  
Psychosocial Oncology ◽  
Distress Screening ◽  
Patient Centered ◽  
Digital Platforms ◽  
Innovative Strategies ◽  
Psychosocial Experiences ◽  
Integrated Medical Care

Patient engagement is ever more essential to developing innovative strategies that shape how comprehensive, integrated medical care is delivered to cancer patients and their families. With over 300 licensed professionals across the network, Cancer Support Community (CSC) is the largest nonprofit employer of psychosocial oncology mental health professionals in the United States. Through decades of working with cancer patients, families, and caregivers, CSC has developed a portfolio of evidence-informed programs that engage patients around their most pressing concerns—unwanted aloneness, loss of control, and lack of hope. CSC’s facilities, which provide support groups, education, exercise and nutrition classes, children’s programs, and social activities, are available at no cost for families. These services are replicated on CSC’s helpline and digital platforms. This chapter highlights a comprehensive integrated model of developing and delivering evidence-informed psychosocial programs and services in the community. The chapter also reviews CSC patient-centered research projects including (1) the Cancer Experience Registry®, an online observational study of cancer patients, survivors, and informal caregivers to identify and quantify their psychosocial experiences; (2) CancerSupportSource®, a reliable, valid, multidimensional distress screening program for patients and caregivers; and (3) Open To Options®, a shared decision-making program that helps patients prepare a highly personalized list of questions, concerns, and goals to share with their doctor. The extent to which the psychosocial oncology community can integrate care across healthcare systems, by leveraging new technologies, behavioral and implementation science principles, and community-based services, will determine its success in meeting the needs of cancer patients.

223Atrial fibrillation screen, management and guideline recommended therapy (AF SMART II) in the rural primary care setting: eHealth tools to support all stages of screening

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Orchard ◽  
J Li ◽  
B Freedman ◽  
R Webster ◽  
C Hespe ◽  
...  
Keyword(s):  
General Practice ◽  
Treatment Guidelines ◽  
Screening Program ◽  
Oral Anticoagulants ◽  
Audit And Feedback ◽  
Screening Process ◽  
Screening Programs ◽  
Electronic Screening ◽  
General Practices ◽  
The Impact

Abstract Funding Acknowledgements National Heart Foundation of Australia: CVRN Grant and Vanguard Grant; investigator-initiated grant from Pfizer-BMS; AliveCor provided free devices BACKGROUND Internationally, most atrial fibrillation (AF) management guidelines recommend screening for AF in people aged ≥65 years, as well as treatment with oral anticoagulants (OAC) for those at high stroke risk ( CHA2DS2-VA ≥2). However, in practice, gaps remain in both screening and treatment. In Australian general practice in 2017, the estimated rate of AF screening was 11%, and only about 60% of diagnosed AF patients received guideline-based OAC. Our 2018 screening study using eHealth tools in metropolitan general practices increased screening to 16% of eligible patients, leading to further refinement of the eHealth tools. PURPOSE To investigate the impact of an AF screening program in rural general practices, using a suite of custom-designed eHealth tools designed to increase the proportion screened and treated for AF in accordance with guidelines. METHODS General practices (n = 8) in rural New South Wales, Australia participated in the study between September 2018 – June 2019. General practitioners (GPs) and practice nurses conducted opportunistic screening of eligible patients (i.e. aged ≥65 years without existing AF diagnosis) using a smartphone electrocardiogram during practice visits. Practices were also provided with 1) an electronic screening prompt (which appeared when an eligible patient’s file was opened); 2) electronic decision support based on ESC/Australian treatment guidelines; and 3) regular customised data reports aimed at quality improvement (Figure 1). A clinical audit tool was used to extract deidentified data from practices. RESULTS A total of 3,103 eligible patients (mean age 75.1 ± 6.8 years, 47% male) who attended the 8 practices during the study period were screened (median screening period 4.6 months). Practices screened a median of 35% of eligible patients (range 9-51% per practice), with 4/8 practices screening >40% of eligible patients. 36 (1.2%) new cases of AF were confirmed (mean age 77.0 years, 64% male, mean CHA2DS2-VA = 2.9). GPs (n = 22) screened 30% (range 1-182 per GP) of patients and nurses (n = 40) screened 70% (range 1-192 per nurse). OAC treatment rates of patients with AF with CHA2DS2-VA≥2 were 82% (screen-detected), 78% (clinically-detected during study period) and 75% (pre-existing AF), with no significant differences between groups. CONCLUSIONS In the rural general practice setting, an AF screening program supported by eHealth tools resulted in 35% of eligible people screened, which is substantially higher than the 16% achieved in our previous study. Half the practices screened 40-50% of eligible patients, suggesting this may represent a ‘ceiling’ of patients captured by opportunistic AF screening programs. OAC treatment rates were higher than previous studies at baseline and were trending upwards during the study. eHealth tools, particularly including customised data reports as part of an audit and feedback system, may be a valuable addition to future screening programs. Abstract Figure 1 - screening process

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.

scholarly journals Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland

2020 ◽  
Vol 196 (12) ◽  
pp. 1068-1079 ◽  
Author(s):  
Christiane Matuschek ◽  
Johannes C. Fischer ◽  
Stephanie E. Combs ◽  
Rainer Fietkau ◽  
Stefanie Corradini ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Screening Program ◽  
Disease Incidence ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Office Work ◽  
Protective Measures ◽  
The Impact

Abstract Purpose COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. Methods We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. Results The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. Conclusion Most ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.

Clinical needs assessment for sexual health among cancer patients receiving pelvic radiation: Implications for development of a radiation oncology sexual health clinic

2018 ◽  
Vol 8 (3) ◽  
pp. 206-212 ◽  
Author(s):  
Jennifer Y. Wo ◽  
Lorraine C. Drapek ◽  
Andrzej Niemierko ◽  
Brenda Silvia ◽  
Bridget N. Noé ◽  
...  
Keyword(s):  
Sexual Health ◽  
Needs Assessment ◽  
Cancer Patients ◽  
Radiation Oncology ◽  
Health Clinic ◽  
Pelvic Radiation

scholarly journals CancerSupportSource®-15+: development and evaluation of a short form of a distress screening program for cancer patients and survivors

2021 ◽  
Author(s):  
Alexandra K. Zaleta ◽  
Shauna McManus ◽  
Erica E. Fortune ◽  
Branlyn W. DeRosa ◽  
Joanne S. Buzaglo ◽  
...  
Keyword(s):  
Psychometric Properties ◽  
Cancer Patients ◽  
Screening Program ◽  
Short Form ◽  
Depression And Anxiety ◽  
Distress Screening ◽  
Community Based ◽  
Stable Factor ◽  
Significant Depression ◽  
Item Quality

Abstract Purpose CancerSupportSource® (CSS) is a distress screening program implemented at community-based organizations and hospitals nationwide. The 25-item CSS assesses distress across five domains, with capacity to screen for clinically significant depression and anxiety. This study examined psychometric properties of a shortened form to enhance screening opportunities when staff or patient burden considerations are significant. Methods Development and validation were completed in multiple phases. Item reduction decisions were made with 1436 cancer patients by assessing external/internal item quality and judging theoretical and practical implications of items. Pearson correlations and confirmatory factor analysis were conducted on a separate sample of 957 patients to corroborate psychometric properties and dimensionality of the shortened scale. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk scales. Results Scale refinement resulted in a 15-item short form plus one screening item assessing tobacco and substance use (CSS-15+). At least two items from each CSS domain were retained to preserve multidimensionality. In confirmatory analysis, the model explained 59% of the variance and demonstrated good fit. Correlation between CSS-15+ and 25-item CSS was 0.99, p < 0.001. Sensitivity of 2-item depression and 2-item anxiety risk scales in the confirmatory sample were 0.82 and 0.83, respectively. Conclusions CSS-15+ is a brief, reliable, and valid multidimensional measure of distress. The measure retained excellent internal consistency (α = 0.94) and a stable factor structure. CSS-15+ is a practical and efficient screening tool for distress and risk for depression and anxiety among cancer patients and survivors, particularly in community-based settings.

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