Does screening for distress efficiently uncover meetable unmet needs in cancer patients?

Abstract

Objectives: We evaluated screening for distress in terms of its ability to uncover unmet need for psychosocial services in cancer patients. Correlates of distress, need for services and met and unmet need for services were investigated.Methods: Immediately after cancer treatment (T1) and 2 months later (T2), 302 patients completed the Hopkins Symptom Checklist-25 (HSCL-25) and a single question assessing the need for services. All distressed patients (HSCL-25X39) and non-distressed patients endorsing a need for services were then called (n 5 99) to assess their need.Results: Thirty-seven percent (T1) and 31% (T2) of patients were distressed and 31% (T1) and 18% (T2) expressed the need for services. Both time points showed higher distress in younger patients and females and lower distress in prostate cancer and patients treated by radiotherapy only. Less need for services was found in prostate cancer (T1), greater need was related to being single (T1) and younger (T2). Distress and need for services were positively related (po0.001). The HSCL-25 showed modest sensitivity (T1: 0.59, T2: 0.65) and specificity (T1: 0.75, T2: 0.78) as an indicator of need for services. Interviews at T2 revealed that 51% of distressed patients needed no psychosocial services and 25% were already receiving services. At T2, regardless of distress level, 10% of all screened patients reported an unmet need for psychosocial services.Conclusions: Depending on the clinical context, screening might be more efficient if it assessed the unmet need for services rather than distress. More attention should be concentrated on directing patients with meetable unmet needs to available services.

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

“…In the earlier mentioned Dutch study in 302 cancer patients, female patients and younger patients were at higher risk of having a high level of PD [28]. In another paper studying 2776 patients with cancer visiting a tertiary cancer center in Canada, significant gender differences were found; female patients reported depressive symptoms more frequently than male patients and were more likely to receive psychosocial support [19].…”

“…After two months, regardless of distress level, 10% of all screened patients reported an unmet need for intervention. The study showed that the need for an intervention was positively related to the level of distress [28]. In a study evaluating 361 referrals for psycho-oncological counseling, 20% of newly referred patients never attended counseling.…”

“…It is therefore important to identify patients with high levels of PD early, to increase awareness of both patients and health care professionals on this topic and if wanted, to offer interventions. Most of the current literature on PD was acquired in patients with cancer treated with a curative intent [19,[24][25][26][27][28]. To our knowledge, no studies were performed so far specifically in patients with bone metastases.…”

Brief Distress Screening in Clinical Practice: Does it Help to Effectively Allocate Psycho-Oncological Support to Female Cancer Inpatients?

“…Screening is not necessarily useful, even if valid screening tools are used [13]. Patients who are correctly identified as highly distressed may still not get help, and even if psychological support is available for these patients, they may not accept it [3].…”

Repeating what is already known without increasing understanding is a waste of resources

“…The prescription is also problematic as it takes for granted that "monitoring/screening" and "communication skills training" will improve the care of patients with cancer. This is far from self-evident (see, e.g., Merckaert et al, 2010;Moore et al, 2013;Ito et al, 2011;van Scheppingen et al, 2011;Salmon & Young, 2011;Salmon et al, 2015). When reading Meggiolaro et al's (2015) study, a series of papers published in The Lancet about a year ago come to mind.…”