Cancer patients’ experiences with and opinions on the process 'Screening of Distress and Referral Need' (SDRN) in clinical practice: A quantitative observational clinical study

Abstract

ObjectiveThis observational clinical study investigated patients’ experiences with and opinions on the Dutch ‘Screening of Distress and Referral Need’ (SDRN) process implemented in oncology practice. Insight into these can guide improvement of the SDRN process.MethodsPatients from hospitals that had implemented SDRN for at least a year completed questions on experiences with essential SDRN process steps (1: completion of the Distress Thermometer and Problem List as screening instrument (DT&PL), 2: information on SDRN+DT&PL, 3: information on referral options, 4: discussing DT&PL responses, 5: referral when needed), and on opinions about SDRN and DT&PL. Descriptive and univariate analyses were conducted.ResultsOf the 498 participants (response = 54%), 81% completed a DT&PL, of whom 86–87% was exposed to steps 2–3 and 76% discussed responses; only three needing care were not offered referral. Sixty-one percent encountered all SDRN steps and 78% would recommend SDRN to others. Recommending SDRN is related to more frequent DT&PL completion (t = -2.5; p≤0.01), receipt of information on SDRN+DT&PL and referral options (X2 = 4.9; p≤0.05 and X2 = 5.9; p≤0.05 respectively), discussion of responses (X2 = 10.2; p≤0.001), and fuller exposure to SDRN process steps (X2 = 14.8; p≤0.01). Percentages (strongly) agreeing were highest on the DT&PL being useful (90%) and suitable (88%), and lowest on burdensome (31%) and time-consuming (28%).ConclusionThe majority of participating patients encountered the steps of the SDRN process considered essential, with 3/5 having encountered all steps. Referral is largely targeted to patients’ need. Patients’ perceived benefit of SDRN increases with fuller exposure to all process steps. Therefore, improvements, particularly in DT&PL completion and discussion of responses should be made.

Effects on patient-reported outcomes of “Screening of Distress and Referral Need” implemented in Dutch oncology practice

“…In short, IKNL-G representatives approached hospitals and informed stakeholders in oncology care about the importance of SDRN, supported implementation, provided centralized project management, and organized mono-and multidisciplinary meetings for professionals of the hospitals to share experiences with implementation and execution of SDRN in clinical practice. Hospitals were urged to appoint a team leader and to form a multidisciplinary team [17]. Cohort 2: After SDRN had been implemented for at least a year according to a hospital, the second cohort (C2) was recruited from the first nine hospitals that met these criteria.…”

“…The Dutch guideline advises that this comprehensive distress screening process takes place during a patient's hospital visit with either the oncologist or the nurse at least every 3 months during treatment and follow-up [4]. Additionally, providing information about the goal of SDRN and the DT&PL and about the expertise of psychosocial and allied healthcare professionals to whom the patient could be referred to was considered essential [17,18].…”

Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

“…There is evidence in cancer settings demonstrating patient acceptability of a five-step process integrating the Distress Thermometer with patient review, need for help and referral information. 48 Further research is needed to ensure use of the Distress Thermometer is integrated within an evidence-based pathway for identification and management of distress. 16,17…”

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?

“…Discrepancies between patient-reported acceptability and professional perceived acceptability exist: Australian data suggest the majority of cancer service representatives felt patients did not want to be asked questions about their distress, with 38% of health services reporting that they never, or rarely, screen for distress [ 21 ]. However, a quantitative study of 498 patients’ experiences with a distress screening program implemented in ten Dutch hospitals found that patients’ evaluations of the process were largely positive [ 22 ]. Opinions were more favorable in patients who more frequently completed the DT and problem checklist and were exposed to information about the tools and a discussion of potential referral options.…”