Meeting the guidelines: Implementing a distress screening intervention for veterans with cancer

Azizoddin, Desiree R.; Lakin, Joshua R.; Hauser, Joshua; Rynar, Lauren; Weldon, Christine B.; Molokie, Robert E.; Enzinger, Andrea C.; Payvar, Susan; Martin, Joanna

doi:10.1002/pon.5565

Cited by 8 publications

(30 citation statements)

References 28 publications

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“…Seven (28% of 25) studies used more than one theory or framework. Besides the theories and frameworks as categorized by Nilsen [ 39 ], the Plan-Do-Study-Act (PDSA) cycle was used in 11 studies [ 42 , 45 , 51 , 55 , 65 , 90 , 94 , 103 , 114 , 140 , 143 ], the UK Medical Research Council framework for complex interventions [ 171 ] and a program logic model were both used in 1 study, respectively [ 93 ] and [ 118 ].…”

Section: Resultsmentioning

confidence: 99%

Trends in guideline implementation: an updated scoping review

et al. 2022

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Background Guidelines aim to support evidence-informed practice but are inconsistently used without implementation strategies. Our prior scoping review revealed that guideline implementation interventions were not selected and tailored based on processes known to enhance guideline uptake and impact. The purpose of this study was to update the prior scoping review. Methods We searched MEDLINE, EMBASE, AMED, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews for studies published from 2014 to January 2021 that evaluated guideline implementation interventions. We screened studies in triplicate and extracted data in duplicate. We reported study and intervention characteristics and studies that achieved impact with summary statistics. Results We included 118 studies that implemented guidelines on 16 clinical topics. With regard to implementation planning, 21% of studies referred to theories or frameworks, 50% pre-identified implementation barriers, and 36% engaged stakeholders in selecting or tailoring interventions. Studies that employed frameworks (n=25) most often used the theoretical domains framework (28%) or social cognitive theory (28%). Those that pre-identified barriers (n=59) most often consulted literature (60%). Those that engaged stakeholders (n=42) most often consulted healthcare professionals (79%). Common interventions included educating professionals about guidelines (44%) and information systems/technology (41%). Most studies employed multi-faceted interventions (75%). A total of 97 (82%) studies achieved impact (improvements in one or more reported outcomes) including 10 (40% of 25) studies that employed frameworks, 28 (47.45% of 59) studies that pre-identified barriers, 22 (52.38% of 42) studies that engaged stakeholders, and 21 (70% of 30) studies that employed single interventions. Conclusions Compared to our prior review, this review found that more studies used processes to select and tailor interventions, and a wider array of types of interventions across the Mazza taxonomy. Given that most studies achieved impact, this might reinforce the need for implementation planning. However, even studies that did not plan implementation achieved impact. Similarly, even single interventions achieved impact. Thus, a future systematic review based on this data is warranted to establish if the use of frameworks, barrier identification, stakeholder engagement, and multi-faceted interventions are associated with impact. Trial registration The protocol was registered with Open Science Framework (https://osf.io/4nxpr) and published in JBI Evidence Synthesis.

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Section: Resultsmentioning

confidence: 99%

Trends in guideline implementation: an updated scoping review

et al. 2022

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“…During the project, patients in VA-outpatient oncology clinics reported significant cancer-related distress due to baseline psychosocial needs, changes in emotional and physical functioning, logistical and financial challenges of receiving cancer care, and lack of instrumental support. 23 Staff education supported successful buy-in, development and implementation of supportive oncology programs. We used a combination of in-service trainings, online trainings, and handouts to provide evidence for distress screening.…”

Section: Discussionmentioning

confidence: 99%

“…Veterans' rates of distress needs and successful outcomes of integration with mental health and social work services have been reported elsewhere. 23 The mean (SD) age for veterans in this cohort was 72 (9.5) years. Participants were primarily African American veterans (70%), with mostly advanced disease (Table 1).…”

Section: Screeningmentioning

confidence: 93%

“…Most veterans were receptive to completing surveys with few refusing to fill out the survey. 23 Medical oncology fellows often used the completed screener to inform their review of systems (by reviewing the Coleman screener Physical and Other Concerns section) and connect with the supportive care staff present in clinic for patient's identifying severe needs (ie, mental health distress or complex psychosocial needs). Veterans' rates of distress needs and successful outcomes of integration with mental health and social work services have been reported elsewhere.…”

Section: Screeningmentioning

confidence: 99%

“…Participants endorsed elevated distress needs compared with other patient populations screened in Chicago through the CSOC for depressed mood, pain, housing, transportation, and physical, nutrition, and treatment concerns. 23 Elevated presence of needs was especially prominent for food, housing and insurance/medical needs; physical concerns; nutrition, and treatment-or care-related concerns. Veterans in this cohort reported extensive financial and housing concerns: 10.4% reported food and housing concerns, 18.6% reported transportation concerns, and 9.0% reported issues paying for medical care or medications (Table 2).…”

Section: Screeningmentioning

confidence: 99%

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Comprehensive and Equitable Care for Vulnerable Veterans With Integrated Palliative, Psychology, and Oncology Care

Martin¹

2021

Federal Practitioner

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Veterans who live with cancer need comprehensive care. The National Comprehensive Cancer Network and the American College of Surgeons Commission on Cancer guidelines recommend evaluating distress and providing appropriate follow-up to all patients with cancer. Methods: We created patient-centered, collaborative clinics to screen for and address cancer-related distress. Medical oncologists received education about available supportive services and instructions on how to make referrals. Participants completed the Coleman Supportive Oncology Collaborative screening questions. Results: Patients in this outpatient US Department of Veterans Affairs medical oncology clinic were primarily older, Af-rican American men. Most veterans screened positive for ≥ 1 type of cancer-related distress. Patients screened for high levels of distress received in-person clinical follow-up for further evaluation and to make immediate referrals to supportive care services. Conclusions: We evaluated patients' needs, made referrals as needed, and helped bring care directly into the oncology clinic. Using a screening tool for cancer-related distress and managing distress with integrated psychosocial providers could improve care coordination and enhance patient-centered supportive oncology care, especially for high-risk patients. A full-time social worker was integrated into the medical oncology clinics based on our program's success.

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