Adherence to the distress screening through oncology nurses and integration of screening results into the nursing process to adapt psychosocial nursing care five years after implementation

Götz, A.; Kröner, Anja; Jenewein, Josef; Spirig, Rebecca

doi:10.1016/j.ejon.2020.101725

Cited by 8 publications

(12 citation statements)

References 34 publications

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Section: Introductionmentioning

confidence: 99%

“…There is a lack of research regarding the reasons for why some patients are not screened for distress 18,33 or do not receive psychological support despite their scoring positive for distress 34 . Routine implementation and requirement for formal certification as a qualified cancer center does not per se improve these shortcomings beyond a certain level 18,29,33 . In a review on implementation of routine distress screening and referral of distressed patients, 29 only five studies were identified to be of sufficient methodological quality.…”

Section: Introductionmentioning

confidence: 99%

“…15,24 Moreover, psychological interventions usually increase treatment adherence 25 and satisfaction, 26,27 may be a mediator in the course and prognosis of cancer, 2,[28][29][30] reduce the length of hospitalizations, 31 reduce financial and emotional burden of health care providers 29 and maximize quality of life in general. 32 There is a lack of research regarding the reasons for why some patients are not screened for distress 18,33 or do not receive psychological support despite their scoring positive for distress. 34 Routine implementation and requirement for formal certification as a qualified cancer center does not per se improve these shortcomings beyond a certain level.…”

mentioning

confidence: 99%

“…34 Routine implementation and requirement for formal certification as a qualified cancer center does not per se improve these shortcomings beyond a certain level. 18,29,33 In a review on implementation of routine distress screening and referral of distressed patients, 29 only five studies were identified to be of sufficient methodological quality.…”

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confidence: 99%

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Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

et al. 2021

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Background: Despite abundant evidence that emotional distress is frequent in cancer patients and associated with adverse health outcomes, distress screening rates and adequate referrals to psychological support programs among those in need are insufficient in many cancer centers. We therefore aimed to analyze patient-and treatment-related barriers to distress screening and referrals to psychological support as a mandatory component of best-practice cancer care. Method:In the present explorative study, latent class analysis was used to identify homogeneous subgroups among 4837 patients diagnosed with cancer between 2011 and 2019.Results: Four subgroups were identified. Patients with a mental disorder and psychopharmacology were least probable to be screened for distress. Together with patients aged 65 or older and male patients, they were also less likely to receive psychological support. Patients hospitalized for 28 days or longer were most likely to be both screened and to receive psychological support.Conclusions: Clinicians and researchers are recommended not neglect patients with mental disorders and psychopharmacological treatment as well as male and elderly patients when screening for distress and providing access to psychological support. K E Y W O R D Sdistress screening, latent class analysis, length of stay, psychiatric disorders, psycho-oncology, psychopharmacology 1 | BACKGROUND Psychological distress 1 has been reported in 30%-50% of cancer patients 2-7 and is persistent even in cancer survivors in 20%-40% of cases. 2,8 Such symptoms often remain unnoticed in primarily somatic treatment settings, 3,[9][10][11][12] even when pronounced psychopathology is present. 9,10,12 As a consequence, consensus-based treatment guidelines have recommended screening for distress in cancer patients as part of routine treatment. 13,14 The process of screening is recommended to facilitate access to psychosocial support to those in need. 15,16 Contrary to this, 25%-80% of patients with cancer do not receive screening. [17][18][19][20] Furthermore, even if identification of distressed patients with cancer is successful, this does not regularly result in referral to adequate psychological support. 9,16,21 A recent meta-analysis 22 and comprehensive review 23 both suggest patients with cancer and a pre-existing mental disorder are at particular risk to be neglected in terms of receiving psychological support. Patient

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

et al. 2021

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“…Prior research found that 19% of patients did not know about psycho‐oncological support for patients with cancer (Dilworth et al, 2014 ). Oncological nursing teams may only find the time to screen an average of 40% of inpatients for distress due to workload (Götz et al, 2019 , 2020 ). This is why results of the present study are needed to allow prioritisation for oncological treatment teams.…”

Section: Discussionmentioning

confidence: 99%

Towards identifying cancer patients at risk to miss out on psycho‐oncological treatment via machine learning

Günther

Kirchebner

Schulze

et al. 2022

European J Cancer Care

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Objective In routine oncological treatment settings, psychological distress, including mental disorders, is overlooked in 30% to 50% of patients. High workload and a constant need to optimise time and costs require a quick and easy method to identify patients likely to miss out on psychological support. Methods Using machine learning, factors associated with no consultation with a clinical psychologist or psychiatrist were identified between 2011 and 2019 in 7,318 oncological patients in a large cancer treatment centre. Parameters were hierarchically ordered based on statistical relevance. Nested resampling and cross validation were performed to avoid overfitting. Results Patients were least likely to receive psycho‐oncological (i.e., psychiatric/psychotherapeutic) treatment when they were not formally screened for distress, had inpatient treatment for less than 28 days, had no psychiatric diagnosis, were aged 65 or older, had skin cancer or were not being discussed in a tumour board. The final validated model was optimised to maximise sensitivity at 85.9% and achieved an area under the curve (AUC) of 0.75, a balanced accuracy of 68.5% and specificity of 51.2%. Conclusion Beyond conventional screening tools, results might contribute to identify patients at risk to be neglected in terms of referral to psycho‐oncology within routine oncological care.

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Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach

Götz

Kröner²,

Jenewein

et al. 2022

Pall Supp Care

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Objectives To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability. Methods In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation. Results Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients’ individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process. Significance of results To improve distress screening performance, the screening process should be tailored to patients’ needs and to nurses’ working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.

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Adherence to the distress screening through oncology nurses and integration of screening results into the nursing process to adapt psychosocial nursing care five years after implementation

Cited by 8 publications

References 34 publications

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

Towards identifying cancer patients at risk to miss out on psycho‐oncological treatment via machine learning

Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach

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