Validation of a biopsychosocial distress screening tool, “You, Your Family and COH Are a Team”

Validation of a Biopsychosocial Distress Screening Tool, SupportScreen, in a Brazilian Cancer Center

OBJECTIVE

Biopsychosocial distress is a common yet often underestimated complication in cancer care. We sought to translate and evaluate the psychometric properties of SupportScreen distress assessment tool in Brazil.

METHODS

A cancer cohort study was conducted at a public hospital in Brazil. The SupportScreen tool underwent transcultural translation into Portuguese. Eligible patients completed the SupportScreen, Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General version (FACT-G). Statistical analyses included confirmatory and exploratory factor analyses (CFA and EFA), comparisons with established distress tools, and assessments of associations with patients' characteristics.

RESULTS

A total of 302 patients were assessed (M:F 35.4%:64.6%; median age: 55). Most patients were diagnosed with breast (29.1%) and gastrointestinal cancer (20.5%), at advanced disease stage (78.8%). CFA identified optimal models for emotional and physical distress; EFA revealed two factors for the logistics of medical care: practical and medical system distress. The concurrent validity of subscales demonstrated significant correlations between distress domains. Sensitivity analyses indicated good performance of emotional and physical domains in identifying distress compared to gold standard criteria. Female patients were more likely to report high emotional distress, while younger age and late disease stage were associated with higher physical distress. Additionally, late disease stage was linked to higher practical distress.

CONCLUSION

Emotional and physical domains demonstrated validity and reliability, aligning with validated measures. Logistics of medical care distress revealed practical and medical system dimensions, expanding understanding of patient challenges. The SupportScreen tool exhibited concurrent validity and sensitivity in identifying distress.

Differences of biopsychosocial distress and requests for psychological assistance between Asian American and non-Hispanic White oncology patients

OBJECTIVE

The purpose of this study was to compare Asian American (AA) to non-Hispanic White (NHW) cancer patients regarding biopsychosocial distress and requests for psychological assistance.

METHODS

This retrospective study included 5627 eligible patients, newly diagnosed with cancer, who completed the 30-item SupportScreen® survey of biopsychosocial distress. The top 10 sources of high distress were assessed. Distress domains (Emotional, Physical/Functional, and Practical) were examined by race/ethnicity. Requests for psychological assistance were also explored by ethnic groups.

RESULTS

Overall, the top 10 sources of high distress were similar between groups and approximately half consisted of concerns regarding physical symptoms. All patients preferred "talking" as their method of receiving assistance for these items. Ratings of emotional, practical, and physical/functional distress were similar between AA and NHW patients. However, AAs (vs. NHWs) requested more assistance regarding physical/functional and practical distress. No difference was observed between these two groups regarding requests for emotional support.

CONCLUSIONS

Overall, our study suggests that healthcare providers should be aware of the physical and practical needs of AA cancer patients and provide culturally sensitive care that addresses these needs.

Association between requests for supportive care assistance and patients' characteristics, prior to treatment in a comprehensive cancer center

Purpose

Patients with cancer experience a wide array of distress symptoms (emotional, practical, physical, and functional), which often hinders their quality of life and survival. Unfortunately, only a small proportion of these patients request assistance for these problems. This study explored the relationship between requests for supportive care assistance and distress of patients newly diagnosed with cancer.

Methods

This study was conducted at city of hope, an NCI‐designated comprehensive cancer center, and included 2658 patients treated between 2009 and 2017. Patients were asked to complete a 30‐item biopsychosocial problem‐related distress survey via SupportScreen^®, prior to any treatment. Correlations between requests for assistance and distress domains were evaluated. Primary types of requests were examined for all patients, and general linear modeling was used to determine the significant predictors of requests for assistance. p‐values <0.05 were considered significant.

Results

Strong correlations were observed between distress subscales and requests for assistance (r ranging from 0.67 to 0.69). The primary types of requests varied by domain: items such as feeling anxious or fearful, finances, and sleep ranked first within the emotional, practical, and physical‐functional domains respectively (∼20% requests for each item). Verbal assistance was generally preferred to the written form of assistance, with the exception of a few items, including finances. Overall, household income of <$100,000 and completing the survey in Spanish were significant predictors of requests for assistance. Regarding the practical and physical‐functional domains, having an advanced stage of disease was significantly related to an increase in demands for assistance. Being older was associated to a decrease in requests for assistance vis‐à‐vis both the emotional and physical functional subscales.

Conclusion

We demonstrated that distress levels were strongly correlated with requests for assistance. Patients' clinical and demographic characteristics such as age, household income, disease stage and survey language were associated with inquiries for psychosocial support, highlighting the importance of targeting interventions towards those most likely to need them, to better aim patients' needs. Therefore, tailoring supportive care assistance to patients' characteristics could help boost the frequency of requests, reduce distress burden, and improve health outcomes.

A Cross-Sectional Study of Distress Levels in Patients with Newly Diagnosed Breast Cancer: The Impact of Race, Ethnicity, and Language Preference

PURPOSE

Our objective was to assess distress levels in female breast cancer patients as a function of race, ethnicity, and preferred language. We hypothesized minority patients and non-English screen-takers would report higher distress levels compared to English screen-takers and non-Hispanic whites.

METHODS

We conducted a retrospective observational study of female breast cancer patients at an NCI designated cancer center from 2009 to 2016 who were administered a validated biopsychosocial distress screening questionnaire. Self-reported data on race and ethnicity was collected.

RESULTS

A total of 3,156 patients were included in the analysis; mean age of 56.3 (SD 12.25) years. The racial/ethnic cohort distribution included 54% non-Hispanic white (NHW), 19% Hispanic, 16% Asian, 7% Black/African American, and 4% other. On multivariable analysis only Hispanic patients were significantly more likely to report overall distress compared to NHW (OR [1.39; CI [1.03-1.87; p=0.03). Asians were significantly less likely to report distress in the functional domain (OR 0.71, CI [0.58-0.88]; p=0.002), while Black patients were significantly more likely to report highest distress levels in the physical (OR 1.53, CI [1.11-2.12]; p=0.01) domain. Hispanic Spanish screen-takers reported significantly more distress compared to Hispanic English screen-takers across all four domains of distress (p<0.05 for all).

CONCLUSIONS

Top sources of distress in female breast cancer patients vary as a function of race, ethnicity, and preferred language. Future studies should focus on identifying effective, culturally appropriate targeted interventions to mitigate emotional distress levels in ethnic and racial minorities as well as non-English speaking patients with breast cancer.

Assessing unmet needs in advanced cancer patients: a systematic review of the development, content, and quality of available instruments

PURPOSE

Advances in treatment, including biological and precision therapies, mean that more people are living with advanced cancer. Supportive care needs likely change across the cancer journey. We systematically identified instruments available to assess unmet needs of advanced cancer patients and evaluated their development, content, and quality.

METHODS

Systematic searches of MEDLINE, CINAHL, Embase, PubMed, and PsycINFO were performed from inception to 11 January 2021. Independent reviewers screened for eligibility. Data was abstracted on instrument characteristics, development, and content. Quality appraisal included methodological and quality assessment, GRADE, feasibility, and interpretability, following consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.

RESULTS

Thirty studies reporting 24 instruments were identified. These were developed for general palliative patients (n = 2 instruments), advanced cancer (n = 8), and cancer irrespective of stage (n = 14). None focused on patients using biological or precision therapies. The most common item generation and reduction techniques were amending an existing instrument (n = 11 instruments) and factor analysis (n = 8), respectively. All instruments mapped to ≥ 5 of 11 unmet need dimensions, with Problems and Needs in Palliative Care (PNPC) and Psychosocial Needs Inventory (PNI) covering all 11. No instrument reported all of the COSMIN measurement properties, and methodological quality was variable.

CONCLUSIONS

Many instruments are available to assess unmet needs in advanced cancer. There is extensive heterogeneity in their development, content, and quality.

IMPLICATIONS FOR CANCER SURVIVORS

Given the growth of precision and biological therapies, research needs to explore how these instruments perform in capturing the needs of people using such therapies.

Emotional problem-related distress screening and its prevalence by cancer type: Assessment by patients' characteristics and level of assistance requested

OBJECTIVE

Emotional problem-related distress is a common issue faced by patients with cancer. However, patients suffering with this emotional burden do not typically seek assistance. This study sought to determine the prevalence of emotional problem-related distress by cancer type, and identify factors correlated with the level of assistance requested.

METHODS

Using the SupportScreen®, patients were screened for emotional problem-related distress at their first or second visit to an NCI designated Comprehensive Cancer Center. General Linear Model was used to test the association between emotional problem-related distress and type of cancer, and the relationship between level of assistance requested and patients' characteristics.

RESULTS

A total of 2,421 patients were included in this analysis. Patients were mostly female (62%), diagnosed with breast (24%), gynecological (16%) or gastrointestinal (15%) cancers. Highest levels of emotional problem-related distress were reported by patients diagnosed with lung, gynecological, breast and gastrointestinal cancers. Level of assistance requested were significantly associated with problem-related distress scores (p < 0.001), which were higher among patients with lower household incomes (p < 0.001) and Spanish as primary language (p = 0.001).

CONCLUSION

Our study found an association between Level of assistance requested and emotional problem-related distress, which were heightened by lower income and Spanish-speaking. Intervention strategies should be considered to increase access to psychosocial support services.

Efficacy of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer: a pre- and post-test clinical trial

Objective:

Breast cancer is the most common cancer in women worldwide. Many of these patients suffer from multiple psychological symptoms. The present study aimed to investigate the impact of acceptance and commitment therapy (ACT) on depression, pain acceptance, and psychological flexibility in married women with breast cancer.

Methods:

The present study was a pre- and post-test clinical trial with intervention and control groups. The research population consisted of women with breast cancer referred to the Ayatollah Yasrebi and Shahid Beheshti Hospitals in Kashan in 2018. Through a purposive sampling method, 40 women were selected and randomly divided into two groups, namely, intervention (n = 20) and control (n = 20). The applied tools included the Depression, Anxiety and Stress Scale (DASS-21), Chronic Pain Acceptance Questionnaire 8 (CPAQ-8), and Acceptance and Action Questionnaire - II (AAQ-II). Data were analyzed by SPSS 16 using descriptive statistics and analysis of variance (ANOVA).

Results:

The results showed that ACT treatment significantly reduced the mean scores of depression compared to the control group (F = 107.72, p < 0.001). The mean scores of pain acceptance (F = 9.58, p < 0.05) and psychological flexibility (F = 10.61, p < 0 .05) significantly increased in comparison with the control group.

Conclusion:

ACT can be considered as an effective therapeutic approach to reduce depression and increase pain acceptance and psychological flexibility in women with breast cancer. These changes appear to be due to improved acceptance of thoughts and feelings associated with cancer and increased psychological flexibility, which is the primary goal of ACT treatment.

Clinical trial registration:

Iranian Registry of Clinical Trials (IRCT), IRCT20190518043620N1.

Couples coping with cancer together: Successful implementation of a caregiver program as standard of care

OBJECTIVE

The couples coping with cancer together program (CCCT) is used to illustrate practical strategies to implement, evaluate, and grow a successful couples-based program in an NCI-designated CCC. CCCT is multimodal program utilizing psychoeducational, strategic, strengths-based, and problem-solving theoretical frameworks. CCCT integrates multiple intervention modalities, as the standard of care: patients/partners biopsychosocial screening, a standardized psychoeducational session, group intervention, and short-term couples counseling.

METHODS

Implementation strategies included: (a) identifying Values-Benefits-Outcomes for key stakeholders, (b) recruiting an interdisciplinary team, (c) utilizing a concurrent development model (implementing program components in small iterations), (d) integrating program into existing institutional processes, and (e) collecting data and credibility.

RESULTS

CCCT prospectively screened 1995 patients/partners simultaneously for biopsychosocial distress and 913 patient/partner completed program evaluations. Program satisfaction was extremely high: "I recommend this program, for other patients/partners (Patients 95.4% Partners 96.4%)." Ten of the 11 participating physicians anonymously surveyed responded and indicated 100% likely/very likely "to recommend the program to other physicians."

CONCLUSIONS

Couples-based programs are underutilized and have been shown to be important for adjustment and increased longevity. Despite barriers in the healthcare environment, implementing couples-based programs into standard of care are feasible. These strategies may be applicable to develop supportive care programs in various health-care settings.