How feasible is implementation of distress screening by cancer clinicians in routine clinical care?

Authors

  • Alex J. Mitchell MD,

    Corresponding author
    1. Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
    • Department of Psycho-oncology, Towers Hospital, Leicestershire Partnership NHS Trust, Leicester LE50TD

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    • Fax: (011) 62956673

  • Karen Lord RGN,

    1. Chemotherapy Department, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
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  • Jo Slattery DCR(T),

    1. Radiotherapy Department, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
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  • Lorraine Grainger BSc,

    1. Chemotherapy Department, University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
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  • Paul Symonds MD

    1. Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, United Kingdom
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Abstract

BACKGROUND:

There is considerable uncertainty regarding the acceptability of routine distress screening.

METHODS:

In an unfunded implementation study, the authors asked 50 clinicians (chemotherapy nurses and treatment radiographers/radiation technologists) to implement a screening program for distress as part of routine care and to record their feedback after each clinical encounter. In total, 379 patients were screened using a simple paper-and-pencil versions of distress thermometer and the emotion thermometer (ET).

RESULTS:

Across all screening applications, clinicians believed that screening was useful during 43% of assessments and was not useful during 35.9% of assessments, and they were unsure or neutral in 21.1% of assessments. The application of the screening program assisted staff in changing their clinical opinion after 41.9% of assessments, and clinicians believed that the screening program helped with communication in >50% of assessments. However, 37.5% believed that screening was impractical for routine use, and more chemotherapy nurses than radiographers rated the screening program as “not useful.” On multivariate analysis, 3 variables were associated with high staff satisfaction with screening, namely, receipt of prior training, talking with the patient about psychosocial issues, and improved detection of psychological problems. A favorable perception of screening also was linked to a change in clinical opinion.

CONCLUSIONS:

Opinions of cancer clinicians regarding routine distress screening were mixed: Approximately 33% considered screening not useful/impractical, whereas >50%n believed promoted good communication and/or helped with recognition. Clinicians who were more positive about screening gained greater benefits from screening in terms of communication and recognition. Cancer 2012. © 2012 American Cancer Society.

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