Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management

Abstract

Purpose of Study: Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals. Primary Practice Setting: Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017. Methodology and Sample: A retrospective, matched case–control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1–3 = mild, 4–7 = moderate, and 8–10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services. Results: More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χ2 p < .001). Implications for Case Management Practice: This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.

‘Patients with Cancer are Distressed!’ Indian Healthcare Provider Perspectives on Distress Screening and Referrals to Psycho-oncology Services – A Mixed Methods Study

“…The level of distress reported in our study is consistent with other studies which predominantly found moderate to extreme levels of distress being reported by patients. [22][23][24][25][26][27] The major concerns reported on the problem checklist such as pain, worry, sleep and fatigue were also similar to other studies. [28] Although patients reported distress in the OPD, the rates of referrals to POS were found to be low which questioned the purpose of implementing routine screening for distress.…”

Telehealth Nursing Research: Adding to the Evidence-base for Healthcare

“…[62][63][64][65] Three papers were in oncology settings. [66][67][68] The last four papers addressed single topics: post-operative monitoring, 69 eoutpatient visits, 70 parenting, 71 and eICU. 72 Six studies described development, testing and evaluation of apps for care delivery.…”