Examination of a distress screening intervention for rural cancer survivors reveals low uptake of psychosocial referrals

Abstract

Purpose To determine the impact of a telemedicine-delivered intervention aimed at identifying unmet needs and cancer-related distress (CRD) following the end of active treatment on supportive care referral patterns. Methods We used a quasi-experimental design to compare supportive care referral patterns between a group of rural cancer survivors receiving the intervention and a control group ( N = 60). We evaluated the impact of the intervention on the number and type of referrals offered and whether or not the participant accepted the referral. CRD was measured using a modified version of the National Comprehensive Cancer Network Distress Thermometer and Problem List. Results Overall, 30% of participants received a referral for further post-treatment supportive care. Supporting the benefits of the intervention, the odds of being offered a referral were 13 times higher for those who received the intervention than those in the control group. However, even among the intervention group, only 28.6% of participants who were offered a referral for further psychosocial care accepted. Conclusions A nursing telemedicine visit was successful in identifying areas of high distress and increasing referrals. However, referral uptake was low, particularly for psychosocial support. Distance to care and stigma associated with seeking psychosocial care may be factors. Further study to improve referral uptake is warranted. Implications for Cancer Survivors Screening for CRD may be inadequate for cancer survivors unless patients can be successfully referred to further supportive care. Strategies to improve uptake of psychosocial referrals is of high importance for rural survivors, who are at higher risk of CRD. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01052-4.

Self-reliance, Social Norms, and Self-stigma as Barriers to Psychosocial Help-Seeking Among Rural Cancer Survivors With Cancer-Related Distress: Qualitative Interview Study

“…We utilized a qualitative descriptive design [ 37 ] to accomplish the study purpose. Participants were patients who had been offered psychosocial referral during a telemedicine intervention [ 27 ]; these patients had been recruited from the head and neck cancer clinic at an National Cancer Institute–designated comprehensive cancer center in the southeastern United States that serves a large rural catchment area and were over 18 years of age, had completed active treatment for head and neck cancer within the past 3 months, and lived in a rural county (which we defined as small metropolitan, micropolitan, or noncore and at least 45 minutes of travel was required to reach the cancer center).…”

“…Demographic, cancer-related, and level of distress data were collected as part of the previous study [ 27 ].…”

“…Yet, this factor does not explain survivors’ unwillingness to receive psychosocial care when distance barriers can successfully be overcome via technology. For example, in a previous study [ 27 , 28 ], we developed and tested a telemedicine-delivered intervention for rural head and neck cancer survivors (called Comprehensive Assistance: Rural, Nursing Interventions and Guidance) to screen for cancer-related distress and make referrals for lingering posttreatment unmet needs. The intervention was designed to overcome technology barriers experienced by individuals living in broadband-poor areas, by offering options for individuals without home-based internet access to connect to a nurse with oncology specialization.…”

“…The intervention was designed to overcome technology barriers experienced by individuals living in broadband-poor areas, by offering options for individuals without home-based internet access to connect to a nurse with oncology specialization. Participants (n=14) who were found to have high cancer-related distress (using a combination of Distress Thermometer and Problem List measurement and a nurses assessment) were referred to a social worker with oncology specialization from the Cancer Center for psychosocial support, who initially contacted patients by phone to discuss the range of support options available (including telephone counseling or support groups in their area); however, fewer than one-third (28.6%) accepted referrals for further psychosocial care [ 27 , 28 ].…”

“…Research has also largely not focused on individuals currently experiencing distress when they are offered services. Given that only 28.6% of rural survivors with high cancer-related distress accepted referral for psychosocial care in our previous study [ 27 ], the purpose of this research was to directly examine the reasons rural cancer survivors accept or do not accept psychosocial referral.…”