Alex Mitchell www.psycho-oncology.infoPaul SymondsLorraine GraingerElena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS2010
680 - Implementation of a Screening Programme for Cancer Related Distress: Part III –
Does Screening Aid Clinicians’ Quality of Care?
680 - Implementation of a Screening Programme for Cancer Related Distress: Part III –
Does Screening Aid Clinicians’ Quality of Care?
Concepts of Implementation
Staff Recognition (unassisted)
Tool Validity (vs gold standard)
Tool acceptability
DetectionClinician managementPatient wellbeing
DetectionClinician managementPatient wellbeing
Before tool
After tool
Pilot tool
Baseline
Defining Quality of Care
Defining Quality of Care
Clinician takes appropriate action
Unmet needs are met
Meetable unmet needs are met, by clinician without delay
800 Patients Approached
100 Not Willing (13%) 700 Patients Willing (87%)
500 Staff Willing (71%)TAU
402 Data Collected (80%)Screen Data
Leicester: DT/ET Implementation T177 t680
Detections before Detections after Care after
Phase II
Phase II Results Post ET (DT)
1. Does tool influence detections?
2. Does screening influence quality of care?
Interim269 Nurse-patient
interactions
Helped 65 (24%) Not Helped 204 (76%)
Unmet Needs 150 (55.8%)
Referred 23 (8.6%) Declined Helped 20 (7.4%)
No Unmet Needs 34 (12.6%)
p179
Overall clinician care
Of 402 nurse-patient interactions:
no action was taken in 62% (of which 10% patients declined)
patient were helped in 38% of consultations.
Of those helped, a referral was made in 25.9% of cases (10% overall)
Clinician Care by Patient distress
Of 183 who screened positive for distress 108 (59%)were helped
Of 219 without distress, 44 (20%) were offered help (Chi² = 14 P < 0.001).
Clinician Care by Patient Depression
Of 70 who screened positive for depression 28 (38.6%)were helped
Of 219 without depression, 48 (22%) were offered help (Chi² = 14 P < 0.001).
2x2 Clinician Help Table : by Diagnosis
24% helped30% helpedAnger
22% helped39% helpedDepression
17.5% helped33% helpedAnxiety
20% helped46% helpedAny
20% helped59% helpedDistress
Diagnosis NoDiagnosis Yes
Effect of Screening…more than distress
Screening influences -
Clarification of patient distress
Clarification of clinician opinion
Clarification of unmet needs
Clarification of desire for help
2x2 Clinician Help Table : ACTUAL HELP
=>??=> InterventionPatient Distressed
=> discharge?=> Monitor?Patient Not distressed orHelp Not Wanted
=> Low grade=> InterventionPatient Says:Help Wanted
Clinician thinks no Unmet Needs
Clinician thinks:Unmet Needs
Clinician help combined
In those with patient reported distress + clinician evaluated distress 22/65 (33.8%) were offered help and 16% offered referral.
In those with neither patient reported nor clinician evaluated distress 10/90 (11.1%) were offered help and 2% offered referral.
In those with patient reported distress + clinician evaluated distress + also wanted help 56% were helped
2x2 Clinician Help Table : ACTUAL HELP
Helped 31/62Helped 65/102Patient Distressed
Helped 20/117Helped 8/35Patient Not distressed orHelp Not Wanted
Helped 11/23Helped 21/35Patient Says:Help Wanted
Clinician thinks no Unmet Needs
Clinician thinks:Unmet Needs
Phase III
Radiotherapy screen implementation
– RCT of screen + intervention
Credits & Acknowledgments
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal InfirmaryJames Coyne University of PennsylvaniaNadia Husain Leicester General HospitalJoanne Herdman Leicester General HospitalJo Kavanagh Leicester Royal Infirmary
For more information www.psycho-oncology.info