Educational intervention in cancer outpatient clinics on routine screening for emotional distress: an observational study

Abstract

Purpose: To examine the possible effect of an educational model on distress screening in newly diagnosed cancer patients referred to Psycho-oncology service (POS).Methods: We examined the differences in distress and problems among newly diagnosed cancer patients referred to POS by cancer care professionals' according to their clinical judgement (2-year period; Study-1) and after an educational intervention on the Distress Thermometer (DT) and Problem List (PL), with referral to those reporting cut-off scores indicative of 'caseness' (DT44) (1-year period; Study-2).Results: In Study-1, 153 (6.7%) of 2268 new patients were referred and seen by the POS, which submitted each patient to the DT/PL. About one-third of the patients (31%) were not DT-cases (scores o 4) and showed lower levels of emotional and relational problems than those who resulted DT-cases. In Study-2, of all newly diagnosed cancer patients (n 5 1107), 583 (52.6%) were administered to the DT/PL by nurses. Two-hundred and eighty-four (52.2%) resulting DT-cases were referred to POS and, of these, 133 (12% of all new patients; 22.81% of those screened; 46.8% of cases) were seen by the POS. There were significant differences in problems between not referred (DT-non-cases) and referred patients (DT-cases).Conclusions: Because of the observational nature of the study, the conclusions should be drawn with caution. The implementation of the routine use of DT/PL seemed to determine a higher (79% increase) and more accurate referral of patients but the rate of acceptance was not high, confirming that more effort is necessary in implementing optimal psychosocial care in oncology.

Effects of screening for psychological distress on patient outcomes in cancer: A systematic review

“…Six studies [55][56][57][58][59][60] did not use a defined cutoff score to indicate a positive screen for heightened distress or to determine which patients would receive further assessment or treatment. In addition, 6 of the studies [58,[60][61][62][63][64] were not RCTs, but were, for example, sequential cohort designs. Finally, 3 of the studies [62][63][64] did not assess distress as an outcome, but investigated other outcomes, such as referral rates.…”

“…Grassi, 2011, Italy [61] Mixed 3375 c Intervention: Following a staff educational intervention, the DT was introduced into clinical practice, with referral to psycho-oncology services for assessment and intervention following positive screens (DT >4). Control: Physicians and nurses were able to refer patients to psycho-oncology services based on clinical judgment.…”

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

“…About half of all patients who stayed at our centres for breast and gynaecological cancers for at least 2 nights received personal offers of bedside psycho-oncological counselling. Offers were accepted by more than 90% of the approached patients, a rate that far exceeds acceptance rates observed in outpatient samples [3,4,5,6,16,28]. There may be several reasons for this divergence: hospitalised cancer patients have been found to suffer from particularly severe distress [9,10]; bedside counselling means less expenditure of time and effort than appointments at external psycho-oncology services, a point that may be particularly relevant for cancer patients many of whom are frail; and moreover, personal invitations by the counsellors themselves may lower the threshold for counselling.…”

Rastreio do Distress, o Sexto Sinal Vital em Oncologia: Dados Preliminares de Doentes Recém-Diagnosticados no Hospital CUF Porto

“…19 No entan- 3 reportaram por sua vez que na sua amostra de 1281 doentes oncológicos, 32% dos mesmos reportava distress com uma intensidade entre 4 e 10 no DT, valor este que se situa no meio do intervalo 25% -50% revelado em estudos precedentes. Grassi e colegas (2013), 2 na revisão realizada observaram dados semelhantes, referindo que de acordo com muitos estudos desenvolvidos, a prevalência de distress oscila entre os 30% e 40%, podendo em alguns casos configurar-se como diagnóstico psiquiátrico, entre os quais se destacam as perturbações de adaptação, as perturbações ansiosas e as perturbações depressivas.…”