Implementing Routine Screening for Distress, the Sixth Vital Sign, for Patients With Head and Neck and Neurologic Cancers

Bultz, Barry D.; Waller, Amy; Cullum, Jodi L; Jones, Paula G.; Halland, Johan; Groff, Shannon L.; Leckie, Catriona; Shirt, Lisa; Blanchard, Scott C.; Lau, Harold; Easaw, Jacob C.; Fassbender, Konrad; Carlson, Linda E.

doi:10.6004/jnccn.2013.0147

Cited by 36 publications

(36 citation statements)

References 29 publications

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“…[4][5][6][7][8] It is widely acknowledged that successful implementation of screening programs depends on health professionals' knowledge and skills 9,10 ; however, health professionals themselves have reported a perceived lack of skills in identifying distress and a lack of guidance around referral pathways. 12 In a recent implementation study of routine screenings for distress in the clinical environment using existing staff, 13 we used a quality improvement methodology to address challenges in following screening protocols, which involved continually identifying and addressing areas in which process change was required. 12 In a recent implementation study of routine screenings for distress in the clinical environment using existing staff, 13 we used a quality improvement methodology to address challenges in following screening protocols, which involved continually identifying and addressing areas in which process change was required.…”

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confidence: 99%

Screening Alone Is Not Enough: The Importance of Appropriate Triage, Referral, and Evidence-Based Treatment of Distress and Common Problems

Carlson

2013

JCO

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See accompanying article on page 3631Hollingworth et al 1 are to be commended on their careful execution of this study, including an adequately powered sample size, long follow-up period, and the addition of a thorough economic analysis, which is rarely undertaken in the context of psychosocial interventions. This is particularly important in countries with nationalized health care systems such as the United Kingdom, where changes to practice may often be widely implemented without knowledge of the economic implications. In general, psychosocial interventions tend to pay for themselves many times over in subsequent cost-offsets, 2,3 but this needs to be examined carefully on a case-by-case basis before widespread implementation. In this study, implementation of the screening-for-distress program did not result in lower subsequent health care costs. However, despite several strengths, major study design limitations may explain this result, temper interpretations, and inform further clinical implementation of screening for distress programs. Though the authors have called their program a needs assessment in their report, the background literature, tools chosen, and the analysis and outcome measures seem to have been designed to test a distress-screening intervention, and my editorial considers the shortcomings of the study in such light.For distress screening programs to be efficacious, three things have to happen: broad identification of patients potentially in need (using the screening tool), further assessment and triage to appropriate services (by adequately trained staff), and evidence-based treatment of symptoms and problems (also by adequately trained professionals across a variety of disciplines). Specific evidence-based treatments would depend on the problems identified but could include cognitive-behavioral therapy, stress reduction, fatigue management, exercise, resource counseling, or family counseling. While step one was followed in this trial, step two did not happen, and therefore step three didn't even have a chance.The major design limitations around these omissions include confounding of treatment and control arms; lack of training of implementation staff; and, most seriously, not following evidence-based triage and referral algorithms (ie, screening and assessment applied as if it were treatment). The staff who delivered the intervention was the same in both the treatment arm, which implemented the screening tool, and the control arm, which did not. Hence, there is concern of a contamination or spill-over effect into the usual care control arm from the distress-screening training for the intervention, which would theoretically increase sensitivity toward psychosocial issues. This would be more of an issue in a trial that showed benefit in both arms. In this case, the result was no benefit in either arm, which mitigates concerns about contamination but raises questions of the adequacy of staff training.Indeed, the training received by the nurses and radiographers was one four-hour seminar "includi...

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Screening Alone Is Not Enough: The Importance of Appropriate Triage, Referral, and Evidence-Based Treatment of Distress and Common Problems

Carlson

2013

JCO

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“…Ten studies were conducted in the UK (Biddle et al, ; Dennison & Shute, ; Ferguson & Aning, ; Fulcher & Gosselin‐Acomb, ; Ghazali et al, ; Hollingworth et al, ; Ipsos Mori, ; Lee, Katona, Bono, & Lewis, ; Mitchell, Lord, Slattery, Grainger, & Symonds, ; Rogers & Lowe, ). Five were conducted in Canada (Carlson, Groff, Maciejewski, & Bultz, ; Carlson, Waller, Groff, & Bultz, ; Carlson et al, ; Fillion et al, ; Bultz et al, ), two in Australia (Ristevski et al, ; Thewes, Butow, & Stuart‐Harris, ) and three in Europe (Dolbeault, Boistard, Meuric, Copel, & Brédart, ; Lynch, Goodhart, Saunders, & O'Connor, ; Thayssen et al, ). Although most studies involved patients with a range of cancer types, three focussed only on patients with head and neck cancer (Bultz et al, ; Ghazali et al, ; Rogers & Lowe, ) and two exclusively on lung cancer (Carlson et al, ; Lynch et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies reported the results of a randomised controlled trial (RCT) (Carlson et al, , ; Carlson, Waller, Groff, Zhong, & Bultz, ; Hollingworth et al, ). A further eight evaluations (Bultz et al, ; Dolbeault et al, ; Ferguson & Aning, ; Fulcher & Gosselin‐Acomb, ; Ghazali et al, ; Ipsos Mori, ; Lee et al, ; Rogers & Lowe, ) presented findings from research or evaluation that aimed to quantify or qualify changes in patient and/or practice outcomes as a result of the HNA. The remaining eight studies reported on work to determine the feasibility or acceptability to practitioners and/or patients of implementing some form of HNA (Biddle et al, ; Dennison & Shute, ; Fillion et al, ; Lynch et al, ; Mitchell et al, ; Ristevski et al, ; Thayssen et al, ; Thewes et al, ).…”

Section: Resultsmentioning

confidence: 99%

The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature

2019

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Objective Globally, cancer services herald the use of Holistic Needs Assessments (HNA). Implementation is, however, heterogeneous. There is a need to understand what effect implementation variation has on patient experience, outcomes and service demand. This is the first study to examine whether the way in which HNA is implemented, impacts on patient outcomes. Methods MEDLINE, AMED, CINAHL, PsycINFO and the Psychological and Behavioural Sciences Collection were searched (June 2000–June 2018). Search strategy included international HNA tools and synonyms for “needs.” An overview of quality was obtained through application of the Mixed Methods Appraisal Tool. Key themes were identified through thematic synthesis. Results Twenty studies were included (RCTs [n = 4], service evaluations [n = 8] and feasibility studies [n = 8]). Implementation approaches and assessor actions were identified and through thematic synthesis were defined as detecting, discussing/dealing, directing and downstream care. The way in which HNA is implemented is more important to understanding outcomes than what is implemented. Conclusion There is a need to conceptualise HNA as a means and not an end in itself. Pursuers of HNA‐led outcomes must understand and strengthen connections between assessment and outcomes. The conceptual framework can assist development of more insightful measures of both process and outcomes.

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“…Initial findings indicated benefits in terms of greater efficiency, rapid identification of key patient concerns, a decrease in patient encounters with the clinic, improvement in patient self‐reports of well‐being and quality of life. From the frontline staff, there was an expression of increased confidence that the clinic was providing comprehensive care to its patients and an increase in comfort with screening …”

Section: Lessons Learnedmentioning

confidence: 99%

Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture

Bultz

2017

Psycho-Oncology

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In medicine, referral to a medical oncology specialty is based on recent history, physical examination, pathology, surgery reports, imaging, blood work, and the patient's vital signs. By contrast, referral to a psychosocial specialist has typically been based on the patients expressed request for psychosocial support or the health care team's observation of the patient's limited adjustment or poor coping with the diagnosis, treatment, or end-of-life distress. These observations are usually based on clinical acumen not on metrics. In psychosocial oncology, by committing to the science of caring and relying on the use of standardized tools to screen for distress, the multidisciplinary cancer care team assess, communicate, and intervene on what is measured. That is, health care providers can begin to address the patients' identified concerns. Branding distress as the 6th vital sign and incorporating screening for distress into standard cancer practice can be an effective strategy to challenging the resistance in implementation of psychosocial oncology in cancer care institutions. Accreditation agencies are endorsing the need to assess patient distress and better manage symptoms of distress as part of routine and standardized patient care. While many international organizations and societies support the importance of screening, implementing screening for distress still has a long way to go to be operationalized in many cancer care programs. Screening for distress when implemented does, however, create an opportunity for psychosocial oncology to extend its reach into cancer care programs and institutions.

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Implementing Routine Screening for Distress, the Sixth Vital Sign, for Patients With Head and Neck and Neurologic Cancers

Cited by 36 publications

References 29 publications

Screening Alone Is Not Enough: The Importance of Appropriate Triage, Referral, and Evidence-Based Treatment of Distress and Common Problems

Screening Alone Is Not Enough: The Importance of Appropriate Triage, Referral, and Evidence-Based Treatment of Distress and Common Problems

The implementation and impact of Holistic Needs Assessments for people affected by cancer: A systematic review and thematic synthesis of the literature

Lessons learned from the science of caring: Extending the reach of psychosocial oncology: The International Psycho-Oncology Society 2016 Sutherland Award Lecture

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