The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care

Brooks, Joanna Veazey; Poague, Claire; Formagini, Taynara Dutra Batista; Sinclair, Christian T.; Nelson-Brantley, Heather V

doi:10.1016/j.jpainsymman.2019.08.024

Cited by 13 publications

(12 citation statements)

References 35 publications

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“…They cannot see the distress the patient may be experiencing due to unmanaged or escalating symptoms, such as a change in gait, a look of fear, anxiety or depression. (2) Without the inclusion of this patient-reported symptom/distress assessment, the clinical conversation is less likely to result in a referral to a supportive care service [20]. (3) An interdisciplinary approach 36% 64%…”

Section: Discussionmentioning

confidence: 99%

Lessons learned about virtual cancer care and distress screening in the time of COVID-19

Bultz

Watson

2021

Support Care Cancer

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Purpose Cancer-related biopsychosocial distress is highly prevalent across the cancer care continuum. The implementation of screening patients for biopsychosocial distress has become a standard of practice in cancer care. With the presence of COVID-19, clinical care has shifted from in-person care to virtual care in many instances. One of the realities of COVID-19 is the significant decrease in screening patients for biopsychosocial symptom burden. Methods Given that screening for distress has become an accreditation standard in many cancer programs, in the province of Alberta, Canada, all patients are screened for distress with every visit to the cancer centre. Given the presence of COVID-19, much of cancer care has shifted to being delivered virtually (through mediums such as Zoom). In this paper, we present pre-and post-COVID data on the frequency of distress screening and its impact on patient care. Results A review of pre-and post-COVID-19 screening for distress questionnaires revealed that patients who received virtual care were less satisfied in the areas of emotional support and received less resources and referrals to supportive care. Conclusion The rapid integration of virtual care without the inclusion of a standardized distress screening tool was akin to a natural experiment, as two groups (virtual and in-person clinic patients) received different levels of care and interventions. Without the inclusion of distress screening, the clinical conversation around symptoms is less likely to occur and results in fewer referrals to best practices in supportive care services. Lessons learned about virtual cancer care without distress screening in the time of COVID-19 demonstrates significantly fewer patients being screened for distress and subsequently has resulted in less supportive care referrals. Going forward, we must find ways to ensure that virtual cancer care continues to support distress screening and best patient-centric care.

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Section: Discussionmentioning

confidence: 99%

Lessons learned about virtual cancer care and distress screening in the time of COVID-19

Bultz

Watson

2021

Support Care Cancer

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“…8 Existe um alto nível de concordância e pontuação entre os sintomas relados pelo paciente e os sintomas observados por médicos. 27 E, portanto, essa questão ainda precisa ser melhor explorada em pacientes com DMD, colhendo dados do ESAS tanto em pacientes quanto em avaliadores e cuidadores.…”

Section: Discussionunclassified

Avaliação de sintomas na distrofia muscular de Duchenne: uma estratégia de cuidado paliativo

et al. 2020

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A avaliação de sintomas na distrofia muscular de Duchenne (DMD) permite o adequado manejo terapêutico e o Edmonton Symptom Assessment System (ESAS) possui esta função: avaliar simultaneamente múltiplos sintomas de pacientes em cuidados paliativos (dor, cansaço, sonolência, náusea, apetite, falta de ar, depressão, ansiedade e bem-estar). Objetivo: Verificar se pacientes com DMD entendem os termos do ESAS e são capazes de graduar seus sintomas por este instrumento. Métodos: 10 pacientes com DMD foram avaliados transversalmente em relação à: compreensão dos itens do ESAS, caracterização dos sintomas (pelo ESAS e Escala de Faces) e medida da função motora. A graduação de sintomas do paciente, pelo ESAS, foi realizada também pelo avaliador. Os dados foram analisados descritivamente e por meio do coeficiente de correlação de Spearman. Resultados: Todos os pacientes compreenderam os sintomas dor, cansaço, sonolência, depressão (tristeza) e bem-estar, já os sintomas náusea, apetite, falta de ar e ansiedade não foram compreendidos por todos. A média geral de todos os sintomas avaliados pela escala ESAS foi abaixo de 5 pontos. Entre os resultados da escala ESAS e Escala de faces, houve correlação forte para os sintomas “depressão” (r= 0,64) e “ansiedade” (r= 0,65). Houve correlação perfeita (r= 1,0) entre ESAS preenchida pelo paciente e pelo avaliador para os itens “depressão” e “ansiedade” e correlação forte (r= 0,82) para “sonolência”. Conclusão: Pacientes com DMD entenderam os termos do ESAS e graduaram seus sintomas por este instrumento, portanto, não há necessidade de alteração dos termos do ESAS para avaliação de pacientes com DMD.

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“…A brief relevant description of aim/purpose, study characteristics, sample characteristics, and key findings can be found in Appendix E, Table 3. One study was a prospective observational study (Ghoshal, Salins, Deodhar, Damani, & Muckaden, 2017), five cohort studies (Barbera et al, 2015;Diplock et al, 2019;Doris Howell et al, 2020;Koesel, Tocchi, Burke, Yap, & Harrison, 2019;Merchant et al, 2019), one systematic review in which nine out of thirty-four studies evaluated effects of patient reported outcome (PROs) tool use on symptom severity over time (Van Egdom et al, 2019), one literature review with thirty articles , one expert opinion with a pilot study (Basch, Barbera, Kerrigan, & Velikova, 2018), and one mix-method design (Brooks, Poague, Formagini, Sinclair, & Nelson-Brantley, 2020).…”

Section: Study and Sample Characteristicsmentioning

confidence: 99%

Piloting a Self-Reported Symptom Assessment Tool in Three Outpatient Oncology Palliative Care Clinics

Patel

Bryant

Mayer

et al. 2021

Preprint

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Background: Palliative care outpatient clinics should assess patients’ symptoms and quality of life prior to visits to guide care and response to treatments. We describe the implementation of a quality improvement initiative to increase symptom and quality of life screening in the outpatient oncology palliative care (OOPC) clinics of one National Cancer Institute-designated Comprehensive Cancer Center. Method: Our quality improvement project structure was based on the RE-AIM framework. Guided by the Plan-Do-Study-Act (PDSA) approach, we focused on assessing effective implementation of the Edmonton Symptom Assessment Scale (ESAS-r ) and one Quality of Life (QoL) question at each OOPC visit. At the end of each 3-week PDSA cycle, barriers and facilitators were recognized and addressed. The implementation’s effectiveness was determined by percentage of adherence using the following formula: [(number of ESAS-r +1 QoL forms completed per clinic/Number of OOPC completed patient appointments per clinic) x 100].Results: A total of 372 patient appointments were completed during the four PDSA cycles, with overall 59% adherence. The first PDSA cycle compliance was 69%, 58% in the second, 52% in the third, and 65% at the last PDSA cycle. The primary barrier was staff turnover.Conclusion: We were able to implement the ESAS-r + 1 QoL form in a complex clinical outpatient setting. We identified barriers for sustainability, including staff turnover. We addressed these barriers by providing robust instructions that outlined an overview of the clinic workflow and education for all staff members involved in the implementation process. Based on our experience, we suggest integrating this form into the electronic medical record to monitor patient outcomes in the outpatient oncology clinics.

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The Role of a Symptom Assessment Tool in Shaping Patient-Physician Communication in Palliative Care

Cited by 13 publications

References 35 publications

Lessons learned about virtual cancer care and distress screening in the time of COVID-19

Lessons learned about virtual cancer care and distress screening in the time of COVID-19

Avaliação de sintomas na distrofia muscular de Duchenne: uma estratégia de cuidado paliativo

Piloting a Self-Reported Symptom Assessment Tool in Three Outpatient Oncology Palliative Care Clinics

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