Adherence to the distress screening through oncology nurses and integration of screening results into the nursing process to adapt psychosocial nursing care five years after implementation

Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach

OBJECTIVES

To improve psychosocial care for oncology inpatients, we implemented screening for distress by means of distress thermometer (DT) at the Comprehensive Cancer Centre Zurich in 2011. Since then, several screening barriers have been reported regarding the application of the DT. This study aimed to evaluate the distress screening process between 2012 and 2016 to identify barriers preventing sustainability.

METHODS

In this sequential explanatory mixed methods study, we synthesized the results of 2 quantitative retrospective descriptive studies and 1 qualitative focus group study. To compare and analyze the data, we used thematic triangulation.

RESULTS

Nurses screened 32% (N = 7034) of all newly admitted inpatients with the DT, and 47% of the screenings showed a distress level ≥5. Of these cases, 9.7% were referred to psycho-oncological services and 44.7% to social services. In 15.7% of these cases, nurses generated a psychosocial nursing diagnosis. In focus group interviews, nurses attributed the low screening rate to the following barriers: adaptation to patients' individual needs, patient-related barriers and resistance, timing, communication challenges, established referral practice, and lack of integration in the nursing process.

SIGNIFICANCE OF RESULTS

To improve distress screening performance, the screening process should be tailored to patients' needs and to nurses' working conditions (e.g., timing, knowledge, and setting-specific factors). To gain more evidence on distress management as a basis for practical improvements, further evaluations of distress screening are required.

Towards identifying cancer patients at risk to miss out on psycho-oncological treatment via machine learning

Objective

In routine oncological treatment settings, psychological distress, including mental disorders, is overlooked in 30% to 50% of patients. High workload and a constant need to optimise time and costs require a quick and easy method to identify patients likely to miss out on psychological support.

Methods

Using machine learning, factors associated with no consultation with a clinical psychologist or psychiatrist were identified between 2011 and 2019 in 7,318 oncological patients in a large cancer treatment centre. Parameters were hierarchically ordered based on statistical relevance. Nested resampling and cross validation were performed to avoid overfitting.

Results

Patients were least likely to receive psycho‐oncological (i.e., psychiatric/psychotherapeutic) treatment when they were not formally screened for distress, had inpatient treatment for less than 28 days, had no psychiatric diagnosis, were aged 65 or older, had skin cancer or were not being discussed in a tumour board. The final validated model was optimised to maximise sensitivity at 85.9% and achieved an area under the curve (AUC) of 0.75, a balanced accuracy of 68.5% and specificity of 51.2%.

Conclusion

Beyond conventional screening tools, results might contribute to identify patients at risk to be neglected in terms of referral to psycho‐oncology within routine oncological care.

Mental disorders, length of hospitalization, and psychopharmacy-New approaches to identify barriers to psychological support for patients with cancer

BACKGROUND

Despite abundant evidence that emotional distress is frequent in cancer patients and associated with adverse health outcomes, distress screening rates and adequate referrals to psychological support programs among those in need are insufficient in many cancer centers. We therefore aimed to analyze patient- and treatment-related barriers to distress screening and referrals to psychological support as a mandatory component of best-practice cancer care.

METHOD

In the present explorative study, latent class analysis was used to identify homogeneous subgroups among 4837 patients diagnosed with cancer between 2011 and 2019.

RESULTS

Four subgroups were identified. Patients with a mental disorder and psychopharmacology were least probable to be screened for distress. Together with patients aged 65 or older and male patients, they were also less likely to receive psychological support. Patients hospitalized for 28 days or longer were most likely to be both screened and to receive psychological support.

CONCLUSIONS

Clinicians and researchers are recommended not neglect patients with mental disorders and psychopharmacological treatment as well as male and elderly patients when screening for distress and providing access to psychological support.

Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer?

How do nurses experience and interpret the screening of hospitalised cancer patients by means of the distress thermometer? - A qualitative study Abstract. Background: People with cancer experience distress and may need professional support. In 2012, the University Hospital Zurich introduced its distress thermometer (DT) screening, whereby all inpatients were to be screened to gauge their support need. However, after five years, the screening rate was 40 % and the referral rate to psycho oncology was 7.9 %, surprisingly low. Aim: The aim of this qualitative study was to describe how nurses experience the screening and how they interpret the screening and referral rate. Methods: The evaluation of three focus group interviews with 14 nurses followed the principles of qualitative content analysis according to Mayring. Results: The analysis revealed four main categories. The first category "Trying to perform useful screening in a complex daily routine" comprises three subcategories: "Using the benefits of screening for comprehensive care", "The best way to recognize the individuality of the counterpart" and "Failing due to structural and personal barriers". Three further main categories addressing nurses' personal attitudes complete the screening experience: "Experiencing fewer difficulties due to competence and experience", "Being careful due to hesitations", and "Reflecting one's responsibility". Conclusions: Nurses want to use the DT. However, they need more practical and scientific support to usefully integrate screening into their everyday life.