Implementation of Electronic Psychosocial Screening Among Caregivers in Pediatric Oncology

Abstract

PURPOSE: This study aimed to evaluate the reach and implementation of an electronic psychosocial screening program among caregivers of pediatric oncology patients, as well as characterize caregiver distress. METHODS: Participants (N = 2,013) included caregivers of patients age 0-17.99 years presenting across 9,280 outpatient oncology visits (median = 2; range = 1-52) from September 2018 to June 2019. At check-ins, caregivers electronically completed the pediatric distress thermometer via a patient-facing electronic health record (EHR) application. Caregiver distress ratings ≥ 8 triggered electronic alerts to medical teams to refer for social work support at point of care. Patient clinical and demographic differences in reach and fidelity were evaluated using univariate chi-square and t-tests. Caregivers reporting high distress were compared with caregivers without reports of high distress using univariate and multivariable logistic regression. RESULTS: The e-screening program was able to reach a caregiver for nearly all children seen during the study period, with 95.5% (1,923/2,013) of patients having a caregiver-completed pediatric distress thermometer. On screeners where caregivers reported high distress, medical teams made appropriate referrals to social work 95.5% (471/493) of the time. Overall, 16.9% (325/1,923) of caregivers ever indicated high distress (score ≥ 8), with caregivers of newly diagnosed (odds ratio = 3.16; 95% CI, 2.12 to 4.71) and on-therapy (odds ratio = 2.81; 95% CI, 2.11 to 3.76) patients being more likely to report high distress, compared with those who were off-treatment for the entire study. CONCLUSION: Leveraging EHR technology to provide evidence-based psychosocial screening can aid in successfully reaching a significant proportion of caregivers of pediatric oncology patients to identify and respond to ongoing psychosocial distress.

Mental Health Care Utilization Among Parents of Children With Cancer

“…Parents provide informal care to their child during and after cancer therapy, 10 and they must balance competing priorities such as work and caregiving to other family members. 11 In addition to witnessing their child’s suffering, the uncertainty of cancer prognosis and financial hardship resulting from medical expenses and lost income may intensify parental distress and trigger MH problems 11 , 12 , 13 and may also become barriers to parents seeking needed MH care. Without timely effective treatment, MH conditions may not only drive morbidity and mortality among parents but also undermine the well-being of their children.…”

“…14,15 Professional societies have developed standards of care that recommend routine psychosocial assessment and interventions for caregivers of children with cancer. 16 Although studies have examined self-reported MH status in caregivers of children with cancer, 10,12,13,[16][17][18] empirical evidence of recommended psychosocial service utilization among caregivers is lacking. We hypothesized that utilization of MH services would be higher among parents of children with cancer than in the general parent population.…”