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