Factors associated with referral offer and acceptance following supportive care problem identification in a comprehensive cancer service

Abstract

To improve understanding of the triage process following distress and problem identification and the factors associated with offer and acceptance of supportive care referrals. Review of patient records/charts at a metropolitan hospital in Melbourne, Australia. Data were collected on problem identifications from 1/1/13 to 30/6/14, including patient demographics, disease and treatment information, responses to the NCCN Distress Thermometer (DT) and Problem Checklist (PC), whether referrals to supportive care services were offered and accepted/declined. Logistic regressions examined factors associated with referral offer and acceptance. Of patients completing the DT/PC, 50.1% reported a high level of distress. Overall, 61% of patients were offered referral(s), with the majority (71%) being accepted. Referrals were more likely to be offered to patients with a greater number of problems (Odds Ratio[OR] = 1.18, 95%CI = 1.12-1.25) and higher distress (OR = 1.68, 95%CI = 1.07-2.64). Referrals were more likely to be accepted by patients with a greater number of problems (OR = 1.12, 95%CI = 1.06-1.19) and lower distress (OR = 0.58, 95%CI = 0.34-1.00). The type of problem experienced by the patient was strongly related to the type of referral they were offered. At a large metropolitan hospital with in-house supportive care services, simple problem identification with the DT/PC enabled triage to services that reflected patients' needs. The findings suggest that clear referral pathways and an organisational emphasis on supportive care may facilitate service use.

The Impact of Illness Perceptions and Coping Strategies on Use of Supportive Care for Cancer

“…Emotionfocused coping strategies describe attempts to regulate the inner turmoil caused by a stressor [34]. Survivorship support services are largely designed to provide informational and educational material as well as emotional support [2]. In availing themselves of psychosocial support services, patients and survivors can gain skills in learning how to live with and adapt to the reality of their illness while finding solace in the comfort and understanding of other patients and support care workers.…”

“…Recent studies reported that over one-third of people with cancer exhibit significant levels of psychological distress [1,2]. Social support has been identified as instrumental in helping cancer patients cope [3].…”

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

“…Supportive care referrals can be made to services such as physical therapy, social work, or pain management to help with CRD [ 2 ]. In the absence of interventions aimed at improving identification of CRD, fewer than 10% of cancer survivors are referred for psychosocial help [ 1 ], although identification of distressed patients and referral rates are far higher when screening tools are routinely used [ 3 , 4 ]. Despite interventions designed to screen and refer individuals with high levels of CRD, uptake of these referrals is limited, typically accepted by only one-quarter of participants identified as needing further care [ 5 , 6 ].…”

Distress and problem assessment among people living with cancer from Culturally and Linguistically Diverse backgrounds

“…3 Previous work has shown that used together the DT and PC, are effective for triaging patients to supportive care services within a metropolitan cancer care centre. 4 Although not all patients will take up referrals, 5 distress screening can facilitate discussions about patients' supportive care needs and opens the door for further communication about their well-being. Patients from diverse cultural and linguistic backgrounds may face additional challenges, which need to be considered in facilitating their participation in distress and problem assessment.…”

“…The Distress Thermometer and Problem Checklist (DT and PC) is a brief, efficacious tool for screening patients' overall distress and key issues of concern 3 . Previous work has shown that used together the DT and PC, are effective for triaging patients to supportive care services within a metropolitan cancer care centre 4 . Although not all patients will take up referrals, 5 distress screening can facilitate discussions about patients' supportive care needs and opens the door for further communication about their well‐being.…”