Psychosocial distress is dynamic across the spectrum of cancer care and requires longitudinal screening for patient-centered care

Disparities in Electronic Screening for Cancer-Related Psychosocial Distress May Promote Systemic Barriers to Quality Oncologic Care

“…These findings are particularly relevant, as many of the under-screened groups have been identified as being at higher risk for psychosocial distress, such as the underinsured and those of lower socioeconomic status. 22,33,34 Prior studies of distress screening have largely used paper surveys administered in clinic; although this process captures nearly all patients offered screening, it is laborious in the context of the multiple other tasks required of clinical staff, and is not as feasible with telemedicine. [7][8][9][10][11][12][13][14][15][16][17][18] Our program is highly efficient in that no ongoing effort is required to administer or input survey results once the system is operational, and providers only become aware of a patient's distress level when they meet predefined "highrisk" thresholds, which are adjustable.…”

“…These patients are generally older, non-White, and of lower socioeconomic status than those who are engaged in electronic healthcare Portals, and may be more likely to experience significant psychosocial distress. 22,33,34 We therefore recommend continued innovations to improve Portal participation at institutions utilizing EHR-based distress screening, as well as supplementation with paper-based or other in-clinic distress screening to achieve efficient yet equal-opportunity psychosocial care for patients with cancer. Finally, we also recommend investigations into whether in-person versus electronic screening yields different results in screened patients, which is entirely unstudied but may have important clinical ramifications.…”

“…The screening instrument consisted of the Patient Health Questionnaire 4 (PHQ-4), to assess anxiety and depression symptoms, and 4 Likert-type questions scored from 0 to 10 to assess insurance/financial, strength, memory, and family-related distress (0 = no distress, 10 = high distress), as previously described. 22 Patients were sent a Portal-based prompt to participate in electronic screening prior to their second in-person oncology clinic visit. Screening surveys were trigged automatically by the EHR Portal upon the scheduling of the first "established patient" encounter with an oncology provider, and therefore required no staff time for screenings to be assigned or sent to patients.…”

“…To date, few studies have reported on distress screening outcomes using this novel method of distress screening, and none have evaluated its implications. 22 Electronic tools embedded within electronic health record (EHR) systems have been effectively used in noncancer settings, such as screening for alcohol use disorder, depression, and adolescent health risk behaviors. [23][24][25] However, patients in rural areas, those with lower educational attainment and income, and those with advanced age report using the internet less than their counterparts.…”

Psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, 2022

“…This implies that psychosocial distress exists along spectrum that extends from normal adjustment issues to syndromes that meet the full diagnostic criteria for a mental disorder (12). Psychosocial distress is a long-term burden for cancer survivors, with implications for their quality of life and oncologic prognosis (13). The magnitude of psychosocial distress in the cancer survivorship cohort is reported as between 20-52% (14).…”