Screening for distress and supportive care needs during the initial phase of the care process: a qualitative description of a clinical pilot experiment in a French cancer center

Abstract

Objective: To provide a qualitative description of a clinical pilot experiment in a French cancer center, conducted by a nurse after the treatment decision consultation attended by new cancer patients during the initial phase of the care process.Methods: The Psychological Distress Thermometer (PDS) and a problem checklist were administered to 255 patients before nurse consultation, helping her to manage the clinical interview, explore patient's distress and supportive care needs, and finally refer the patients in need to the required Supportive Care units.Results: Patients were primarily referred to the social service unit (35% patients), followed by the physiotherapy unit (23.9%) and the psycho-oncology unit (19.6% of patients). In cases of significant distress (43% patients with PDS43), the percentage of patients referred to the psychosocial units increased (44% referred to the Social Unit, 35% to the Psycho-Oncology Unit). However, the main interest of our screening procedure resides in its qualitative and didactic dimension, based on clinical training and cooperation with healthcare professionals during the process of investigating patients' distress and their supportive care needs. Difficulties and limitations are also described.Conclusions: This first clinical experiment conducted among dedicated nurses involved in a Therapeutic Decision Consultation in a French cancer center has provided evidence in support of the idea that non-specialist professionals are able to identify patients' distress and their Supportive Care needs (particularly in the psychosocial field) provided that they have received appropriate training.

Patients' and clinicians' experiences of holistic needs assessment using a cancer distress thermometer and problem list: A qualitative study

“…A further key issue is to respond to barriers surrounding the discussion of psychosocial distress, which were prominent in these data. Furthering others' suggestion (Carlson et al, 2012;Dolbeault et al, 2011;National Institute for Clinical Excellence, 2014) these data indicate that further training is likely to be crucial towards addressing clinicians' low confidence and enabling them to deliver the psychosocial needs assessments effectively. Patients' understandings of the radiographer/ chemotherapy nurse remit should also be tackled.…”

“…Training is also pinpointed as important where non-specialist professionals are involved in distress screening and needs assessment (Carlson et al, 2012;Dolbeault et al, 2011). Further understanding of such issues is essential to ensure interventions aiming to reduce distress benefit patients.…”

Psychosocial screening effects on health‐related outcomes in patients receiving radiotherapy. A cluster randomised controlled trial

“…In our study, one radiotherapist did not discuss the SIPP with the patients at all during consultation . In addition, in line with the study of Dolbeault and colleagues , there was a certain amount of (initial) resistance because two of the seven radiotherapists did not recognise the value of psychosocial screening . The fourth limitation is that we collected no data about the content of psychosocial support received and/or whether the support was sufficient to cope with the psychosocial and medical aspects of the cancer.…”

Understanding why cancer patients accept or turn down psycho-oncological support: a prospective observational study including patients’ and clinicians’ perspectives on communication about distress

“…Some studies found that patients who reported a higher burden of emotional symptoms were more likely to access services than those who reported a lower burden of symptoms [12–16]. Referral rates and resource utilization still seem low, given documented high levels of distress.…”