Evaluation of an electronic psycho-oncological adaptive screening program (EPAS) with immediate patient feedback: findings from a German cluster intervention study

Abstract

Purpose Distress screening has become mandatory and essential in comprehensive cancer care. We evaluated an electronic psycho-oncological adaptive screening (EPAS) which assesses objective indicators of care needs and subjectively perceived care needs and subsequently provides patient feedback with individualized recommendations about psychosocial care services. Methods Patients were assessed within clusters, i.e., different oncological facilities of the competence network of the University Cancer Center Hamburg (UCCH). Patients in the intervention arm underwent the screening, controls received standard care. Patients were assessed at baseline (t0), 3-month (t1), and 6-month (t2) follow-up. Outcomes included information level and use of/access to nine psychosocial services at UCCH, well-being (GAD-7, PHQ-9, SF-8), and treatment satisfaction (SCCC). Conditional linear and logistic regressions were used to identify screening effects at t1 and t2. Results Of 1320 eligible patients across 11 clusters, 660 were included (50%). The average age was 60 years; 46% were female. The intervention was associated with increased information level for all psychosocial services at t1 and t2 (all p < .001), increased use in some of these services at t1 and t2, respectively (p ≤ .02), and better evaluation of access (e.g., more recommendations for services provided by physicians, p < .01). At t2, the intervention was associated with a lower level of satisfaction with disease-related information (p = .02). Conclusions EPAS may improve information about psychosocial services as well as utilization of and access to these services. The effect on information level seems not to be generalizable to other aspects of oncological care. Future studies should incorporate novel technologies and condense the procedure to its core factors. Implications for Cancer Survivors: The screening may help to enhance self-management competencies among cancer survivors. Trial registration The trial was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).

Effect of depression, anxiety, and distress screeners on the need, intention, and utilization of psychosocial support services among cancer patients

“…Furthermore, some patients were excluded due to technical problems or incapability to use the EPAS program ( n =33) and too few questionnaire data available ( n =198). For more details on participant flow, see previous publication [ 21 ].…”

“… Since this is a secondary analysis, this table has already been published in a very similar form [ 21 ]; all values based on t0 sample ( N= 660) if not otherwise stated; SD, standard deviation; a size and extent of the tumor, excluding hematological caner; b absence or presence and extent of regional lymph node metastasis, excluding hematological cancer; c the absence or presence of distant metastasis, excluding hematological cancer; d excluding hematological cancer; g PHQ-9 at baseline, sum score according to existing ASCO guidelines: none to mild symptomatology: <8, moderate to severe symptomatology: ≥8; h GAD-7 at baseline, sum score according to existing ASCO guidelines: none to mild symptomatology: <10, moderate to severe symptomatology: ≥10; i DT at baseline, clinically relevant level of distress: ≥5 …”

“…The data for this secondary analysis was obtained from a controlled cluster intervention study evaluating a psycho-oncological online-screening program among cancer patients [ 21 ]. The intervention group received a tablet-based adaptive screening application, which provides immediate feedback and recommendations for psychosocial support at the UCCH.…”

“…The control group had the same access to psychosocial support services at UCCH as the intervention group but did not receive any feedback on their assessment. The intervention was not associated with any of the measures (screeners) used in the current study [ 21 ].…”

Falling off the screening grid—Predictors for postponed utilization of psycho‐oncological support in cancer patients and its implications for distress assessment and management

“…However, study results already indicate areas of potential improvement for ePOS: since the used term 'yes, later' can be understood ambiguously, for example, meaning: "yes, I feel a subjective need, but for various reasons I cannot utilize support now" or "currently I'm fine, but I want to utilize support later", the selection of clearer language for those who do not feel addressed by either 'yes' or 'no' seems very important. In line with findings from Esser et al, 37 items, which directly combine assessment responses with suitable support options and possible reasons for postponing support utilization -adding more context to reported issues -should be integrated. 38 As important as that, distress might be as well related to rather physical or social issues.…”