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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 DOI: 10.1200/op.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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2
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Kansara B, Basta A, Mikhael M, Perkins R, Reisman P, Hallanger-Johnson J, Rollison DE, Nguyen OT, Powell S, Gilbert SM, Turner K. Suicide Risk Screening for Head and Neck Cancer Patients: An Implementation Study. Appl Clin Inform 2024; 15:404-413. [PMID: 38777326 PMCID: PMC11111312 DOI: 10.1055/s-0044-1787006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/27/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES There is limited research on suicide risk screening (SRS) among head and neck cancer (HNC) patients, a population at increased risk for suicide. To address this gap, this single-site mixed methods study assessed oncology professionals' perspectives about the feasibility, acceptability, and appropriateness of an electronic SRS program that was implemented as a part of routine care for HNC patients. METHODS Staff who assisted with SRS implementation completed (e.g., nurses, medical assistants, advanced practice providers, physicians, social workers) a one-time survey (N = 29) and interview (N = 25). Quantitative outcomes were assessed using previously validated feasibility, acceptability, and appropriateness measures. Additional qualitative data were collected to provide context for interpreting the scores. RESULTS Nurses and medical assistants, who were directly responsible for implementing SRS, reported low feasibility, acceptability, and appropriateness, compared with other team members (e.g., physicians, social workers, advanced practice providers). Team members identified potential improvements needed to optimize SRS, such as hiring additional staff, improving staff training, providing different modalities for screening completion among individuals with disabilities, and revising the patient-reported outcomes to improve suicide risk prediction. CONCLUSION Staff perspectives about implementing SRS as a part of routine cancer care for HNC patients varied widely. Before screening can be implemented on a larger scale for HNC and other cancer patients, additional implementation strategies may be needed that optimize workflow and reduce staff burden, such as staff training, multiple modalities for completion, and refined tools for identifying which patients are at greatest risk for suicide.
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Affiliation(s)
- Bhargav Kansara
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Ameer Basta
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Marian Mikhael
- Department of Oncological Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
| | - Randa Perkins
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida, United States
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, Florida, United States
| | - Phillip Reisman
- Department of Clinical Informatics, Center for Digital Health, Moffitt Cancer Center, Tampa, Florida, United States
| | - Julie Hallanger-Johnson
- Mayo Clinic College of Medicine and Science, Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Rochester, Minnesota, United States
| | - Dana E. Rollison
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, United States
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States
| | - Sean Powell
- Department of Social Work, Moffitt Cancer Center, Tampa, Florida, United States
| | - Scott M. Gilbert
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, United States
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, United States
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida, United States
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3
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Tsao PA, Fann JR, Nevedal AL, Bloor LE, Krein SL, Caram ME. A Positive Distress Screen…Now What? An Updated Call for Integrated Psychosocial Care. J Clin Oncol 2023; 41:4837-4841. [PMID: 37441747 PMCID: PMC10617941 DOI: 10.1200/jco.22.02719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/03/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
How can we move collaborative care from evidence-based practice to everyday practice for those living with cancer and distress?
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Affiliation(s)
- Phoebe A. Tsao
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Psychosocial Oncology, Fred Hutchinson Cancer Center, Seattle, WA
| | - Andrea L. Nevedal
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Lindsey E. Bloor
- Department of Psychiatry, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Sarah L. Krein
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Megan E.V. Caram
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Veterans Affairs Health Services Research & Development, Center for Clinical Management & Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Rohan EA, Boehm JE, Samarasinha R, Stachon K, Gallaway MS, Huang G, Ng D, Manian N. Diving deeper into distress screening implementation in oncology care. J Psychosoc Oncol 2023; 41:645-660. [PMID: 37655693 PMCID: PMC10964759 DOI: 10.1080/07347332.2023.2250774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Responding to calls for additional research that identifies effective distress screening (DS) processes, including referral practices subsequent to screening and receipt of recommended care, we engaged in qualitative research as part of a larger (mixed methods) study of distress screening. This qualitative inquiry of oncology professionals across different facilities in the United States examined routine DS implementation, facilitators and challenges staff encounter with DS processes, and staff members' perceived value of DS. PARTICIPANTS AND METHODS We conducted key informant interviews and focus groups with staff in 4 Commission on Cancer (CoC)-accredited oncology facilities (a total of 18 participants) to understand implementation of routine DS within oncology care. We used a rigorous data analysis design, including inductive and deductive approaches. RESULTS Respondents believe DS enhances patient care and described ways to improve DS processes, including administering DS at multiple points throughout oncology care, using patient-administrated DS methods, and enhancing electronic health records infrastructure to better collect, record, and retrieve DS data. Respondents also identified the need for additional psychosocial staff at their facilities to provide timely psychosocial care. CONCLUSIONS Results reinforce the value of DS in cancer care, including the importance of follow-up to screening with psychosocial oncology providers. Understanding and resolving the barriers and facilitators to implementing DS are important to ensure appropriate psychosocial care for people with cancer. Insights from oncology staff may be used to enhance the quality of DS and subsequent psychosocial care, which is an essential component of oncology care.
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Affiliation(s)
- Elizabeth A. Rohan
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer E. Boehm
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruvini Samarasinha
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen Stachon
- American College of Surgeons, Commission on Cancer, Chicago, IL
| | - M. Shayne Gallaway
- Arizona Department of Public Health, Phoenix, AZ, USA
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Grace Huang
- Public Health, Westat Inc., Rockville, MD, USA
| | - Diane Ng
- Public Health, Westat Inc., Rockville, MD, USA
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Hahn EE, Munoz-Plaza CE, Lyons LJ, Lee JS, Pounds D, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Gould MK. Barriers and facilitators to implementation and sustainment of guideline-recommended depression screening for patients with breast cancer in medical oncology: a qualitative study. Support Care Cancer 2023; 31:461. [PMID: 37436477 DOI: 10.1007/s00520-023-07922-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Implementation of guideline-recommended depression screening in oncology presents numerous challenges. Implementation strategies that are responsive to local context may be critical elements of adoption and sustainment. We evaluated barriers and facilitators to implementation of a depression screening program for breast cancer patients in a community medical oncology setting as part of a cluster randomized controlled trial. METHODS Guided by the Consolidated Framework for Implementation Research, we employed qualitative methods to evaluate clinician, administrator, and patient perceptions of the program using semi-structured interviews. We used a team-coding approach for the data; thematic development focused on barriers and facilitators to implementation using a grounded theory approach. The codebook was refined through open discussions of subjectivity and unintentional bias, coding, and memo applications (including emergent coding), and the hierarchical structure and relationships of themes. RESULTS We conducted 20 interviews with 11 clinicians/administrators and 9 patients. Five major themes emerged: (1) gradual acceptance and support of the intervention and workflow; (2) compatibility with system and personal norms and goals; (3) reinforcement of the value of and need for adaptability; (4) self-efficacy within the nursing team; and (5) importance of identifying accountable front-line staff beyond leadership "champions." CONCLUSIONS Findings suggest a high degree of acceptability and feasibility due to the selection of appropriate implementation strategies, alignment of norms and goals, and a high degree of workflow adaptability. These findings will be uniquely helpful in generating actionable, real-world knowledge to inform the design, implementation, and sustainment of guideline-recommended depression screening programs in oncology. TRIAL REGISTRATION ClinicalTrials.gov #NCT02941614.
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Affiliation(s)
- Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Corrine E Munoz-Plaza
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Janet S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
| | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave., Pasadena, CA, 91101, USA
- Southern California Permanente Medical Group Performance Assessment team (as of 11/2020), Pasadena, CA, USA
| | | | - Farah M Brasfield
- Southern California Permanente Medical Group, Department of Medical Oncology, Anaheim, CA, USA
| | - Lara N Durna
- Southern California Permanente Medical Group, Department of Medical Oncology, South Bay, CA, USA
| | - Karen W Kwan
- Southern California Permanente Medical Group, Department of Medical Oncology, Los Angeles, CA, USA
| | - David B Beard
- Southern California Permanente Medical Group, Department of Medical Oncology, Woodland Hills, CA, USA
| | - Alexander Ferreira
- Southern California Permanente Medical Group, Department of Medical Oncology, West Los Angeles, CA, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Zaleta AK, Miller MF, Fortune EE, Olson JS, Rogers KP, Hendershot K, Ash-Lee S. CancerSupportSource TM -Caregiver: Development of a distress screening measure for cancer caregivers. Psychooncology 2023; 32:418-428. [PMID: 36604371 DOI: 10.1002/pon.6092] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/29/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Given the substantial demands of cancer caregiving, practical and psychometrically sound tools to evaluate distress among cancer caregivers are needed. CancerSupportSourceTM -Caregiver is a distress screening, referral, and support program designed to identify the unmet needs of cancer caregivers and link caregivers to desired resources and support. This study refined and finalized the CancerSupportSource-Caregiver screening measure and examined its psychometric properties. METHODS Using an analytic sample of 400 caregivers to people with cancer, we first performed item reduction by assessing exploratory factor analysis, external/internal item quality, and judging theoretical and practical implications of items. Confirmatory factor analysis along with reliability and validity analyses were then conducted to corroborate dimensionality and psychometric properties of the final measure. Nonparametric receiver operating characteristic curve analyses determined scoring thresholds for depression and anxiety risk subscales. RESULTS Scale refinement resulted in an 18-item measure plus one screening item assessing tobacco and substance use. Items represented five domains of caregiver concerns: emotional well-being, patient well-being, caregiving tasks, finances, and healthy lifestyle. Our analyses showed strong internal consistency and test-retest reliability, a replicable factor structure, and adequate convergent, discriminant, and known groups validity. Sensitivity of 2-item depression and 2-item anxiety risk subscales were 0.95 and 0.87, respectively. CONCLUSIONS CancerSupportSource-Caregiver is a reliable and valid multidimensional measure of caregiver distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow-up program to rapidly assess caregivers' unmet needs and enhance caregiver well-being across the care continuum.
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Affiliation(s)
- Alexandra K Zaleta
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Melissa F Miller
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Erica E Fortune
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Julie S Olson
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | - Kimberly Papay Rogers
- Cancer Support Community, Research and Training Institute, Philadelphia, Pennsylvania, USA
| | | | - Susan Ash-Lee
- Cancer Support Community, Washington, District of Columbia, USA
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Ke Y, Tan YY, Neo PSH, Yang GM, Loh KWJ, Ho S, Tan YP, Ramalingam MB, Quah DSC, Chew L, Si PEH, Tay BC, Chan A. Implementing an Inclusive, Multidisciplinary Supportive Care Model to Provide Integrated Care to Breast and Gynaecological Cancer Survivors: A Case Study at an Asian Ambulatory Cancer Centre. Int J Integr Care 2023; 23:14. [PMID: 36936536 PMCID: PMC10022533 DOI: 10.5334/ijic.6480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Introduction Supportive care models considering inclusivity and community services to improve integrated care for cancer survivors are limited. In this case study, we described the implementation of a multidisciplinary care model employing routine distress screening and embedded integrated care pathways to integrate care across disciplines and care sectors, while remaining inclusive of the multi-ethnic and multilingual population in Singapore. We reported implementation outcomes after 18 months of implementation. Description We reviewed the model's process indicators from September 2019 to February 2021 at the largest public ambulatory cancer centre. Outcomes assessed included penetration, fidelity to screening protocol, and feasibility in three aspects - inclusiveness of different ethnic and language groups, responsiveness to survivors reporting high distress, and types of community service referrals. Discussion/conclusion We elucidated opportunities to promote access to community services and inclusivity. Integration of community services from tertiary settings should be systematic through mutually beneficial educational and outreach initiatives, complemented by their inclusion in integrated care pathways to encourage systematic referrals and care coordination. A hybrid approach to service delivery is crucial in ensuring inclusivity while providing flexibility towards external changes such as the COVID-19 pandemic. Future work should explore using telehealth to bolster inclusiveness and advance community care integration.
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Affiliation(s)
- Yu Ke
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
| | - Yung Ying Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
| | | | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
- Duke-NUS Medical School Singapore, SG
- Department of General Medicine, Sengkang General Hospital, SG
| | - Kiley Wei-Jen Loh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
| | - Shirlynn Ho
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
| | - Yee Pin Tan
- Department of Psychosocial Oncology, National Cancer Centre Singapore, SG
| | | | - Daniel Song Chiek Quah
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
- Division of Radiation Oncology, National Cancer Centre Singapore, SG
| | - Lita Chew
- Department of Pharmacy, National University of Singapore, SG
- Department of Pharmacy, National Cancer Centre Singapore, SG
| | - Phebe En Hui Si
- Department of Pharmacy, National Cancer Centre Singapore, SG
| | - Beng Choo Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG
| | - Alexandre Chan
- Duke-NUS Medical School Singapore, SG
- Department of Pharmacy, National Cancer Centre Singapore, SG
- Department of Clinical Pharmacy Practice, University of California Irvine, US
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8
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Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of distress management in inpatients with cancer by means of the distress thermometer: A mixed methods approach. Palliat Support Care 2022:1-8. [PMID: 36367151 DOI: 10.1017/s1478951522001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
| | - Anja Kröner
- Department of Oncology, Cantonal Hospital Glarus AG, Glarus, Switzerland
| | - Josef Jenewein
- Comprehensive Cancer Centre Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, University Hospital Graz, Graz, Austria
- Private Clinic Hohenegg, Meilen, Switzerland and University of Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Department of Nursing Science, University Witten/Herdecke, Witten, Germany
- Institute of Nursing Science, University of Basel, Basel, Switzerland
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Deuning-Smit E, Kolsteren EEM, Kwakkenbos L, Custers JAE, Hermens RPMG, Prins JB. Barriers and facilitators for implementation of the SWORD evidence-based psychological intervention for fear of cancer recurrence in three different healthcare settings. J Cancer Surviv 2022:10.1007/s11764-022-01285-x. [DOI: 10.1007/s11764-022-01285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
Abstract
Purpose
Fear of cancer recurrence (FCR) interventions are effective, but few are implemented. This study aimed to identify barriers and facilitators for implementing the evidence-based blended SWORD intervention in routine psycho-oncological care.
Methods
Semi-structured interviews with 19 cancer survivors and 18 professionals from three healthcare settings assessed barriers and facilitators in six domains as described by the determinant frameworks of Grol and Flottorp: (1) innovation, (2) professionals, (3) patients, (4) social context, (5) organization, and (6) economic and political context.
Results
In the innovation domain, there were few barriers. Facilitators included high reliability, accessibility, and relevance of SWORD. In the professional domain, physicians and nurses barriers were lack of self-efficacy, knowledge, and skills to address FCR whereas psychologists had sufficient knowledge and skills, but some were critical towards protocolized treatments, cognitive behavioral therapy, or eHealth. Patient domain barriers included lack of FCR awareness, negative expectations of psychotherapy, and unwillingness/inability to actively engage in treatment. A social context domain barrier was poor communication between different healthcare professionals. Organization domain barriers included inadequate referral structures to psychological services, limited capacity, and complex legal procedures. Economic and political context domain barriers included lack of a national implementation structure for evidence-based psycho-oncological interventions and eHealth platform costs.
Conclusions
Implementation strategies should be targeted at patient, professional, organizational and economic and political domains. Identified barriers and facilitators are relevant to other researchers in psycho-oncology that aim to bridge the research-practice gap.
Implications for cancer survivors
This study contributes to the implementation of evidence-based psychological interventions for cancer survivors, who can benefit from these services.
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Biddell CB, Spees LP, Petermann V, Rosenstein DL, Manning M, Gellin M, Padilla N, Samuel-Ryals CA, Birken SA, Reeder-Hayes K, Deal AM, Cabarrus K, Bell RA, Strom C, DeAntonio PA, Young TH, King S, Leutner B, Vestal D, Wheeler SB. Financial Assistance Processes and Mechanisms in Rural and Nonrural Oncology Care Settings. JCO Oncol Pract 2022; 18:e1392-e1406. [PMID: 35549521 PMCID: PMC9509146 DOI: 10.1200/op.21.00894] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/28/2022] [Accepted: 04/06/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with cancer are at heightened risk of experiencing financial hardship. Financial navigation (FN) is an evidence-based approach for identifying and addressing patient and caregiver financial needs. In preparation for the implementation of a multisite FN intervention, we describe existing processes (ie, events and actions) and mechanisms (ie, how events work together) connecting patients to financial assistance, comparing rural and nonrural practices. METHODS We conducted in-depth, semistructured interviews with stakeholders (ie, administrators, providers, and staff) at each of the 10 oncology care sites across a single state (five rural and five nonrural practices). We developed process maps for each site and analyzed stakeholder perspectives using thematic analysis. After reporting findings back to stakeholders, we synthesized themes and process maps across rural and nonrural sites separately. RESULTS Eighty-three stakeholders were interviewed. We identified six core elements of existing financial assistance processes across all sites: distress screening (including financial concerns), referrals, resource connection points, and pharmaceutical, insurance, and community/foundation resources. Processes differed by rurality; however, facilitators and barriers to identifying and addressing patient financial needs were consistent. Open communication between staff, providers, patients, and caregivers was a primary facilitator. Barriers included insufficient staff resources, challenges in routinely identifying needs, inadequate preparation of patients for anticipated medical costs, and limited tracking of resource availability and eligibility. CONCLUSION This study identified a clear need for systematic implementation of oncology FN to equitably address patient and caregiver financial hardship. Results have informed our current efforts to implement a multisite FN intervention, which involves comprehensive financial toxicity screening and systematization of intake and referrals.
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Affiliation(s)
- Caitlin B. Biddell
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Lisa P. Spees
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Victoria Petermann
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC
| | - Donald L. Rosenstein
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Michelle Manning
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Mindy Gellin
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Neda Padilla
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Cleo A. Samuel-Ryals
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Sarah A. Birken
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Katherine Reeder-Hayes
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Division of Oncology, Chapel Hill, NC
| | - Allison M. Deal
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Kendrel Cabarrus
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
| | - Ronny A. Bell
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | - Carla Strom
- Wake Forest School of Medicine, Winston-Salem, NC
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Tiffany H. Young
- Novant Health Cancer Institute, Buddy Kemp Support Center, Charlotte, NC
| | - Sherry King
- Carteret Health Care Cancer Center, Morehead City, NC
| | | | | | - Stephanie B. Wheeler
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, NC
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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11
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Aronoff-Spencer E, McComsey M, Chih MY, Hubenko A, Baker C, Kim J, Ahern DK, Gibbons MC, Cafazzo JA, Nyakairu P, Vanderpool RC, Mullett TW, Hesse BW. Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study. J Med Internet Res 2022; 24:e29492. [PMID: 35412457 PMCID: PMC9044168 DOI: 10.2196/29492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/21/2021] [Accepted: 10/21/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. OBJECTIVE The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. METHODS We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. RESULTS We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=-0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. CONCLUSIONS Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches.
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Affiliation(s)
- Eliah Aronoff-Spencer
- Design Lab, University of California San Diego, La Jolla, CA, United States
- Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego School of Medicine, La Jolla, CA, United States
| | - Melanie McComsey
- Design Lab, University of California San Diego, La Jolla, CA, United States
| | - Ming-Yuan Chih
- Department of Health & Clinical Sciences, College of Health Sciences, University of Kentuck, Lexington, CA, United States
| | - Alexandra Hubenko
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
| | - Corey Baker
- Department of Computer Science, College of Engineering, University of Kentucky, Lexington, KY, United States
| | - John Kim
- Department of Health & Clinical Sciences, College of Health Sciences, University of Kentuck, Lexington, CA, United States
| | - David K Ahern
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | | | | | | | | | - Timothy W Mullett
- Department of Health & Clinical Sciences, College of Health Sciences, University of Kentuck, Lexington, CA, United States
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12
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Cooley ME, Mazzola E, Xiong N, Hong F, Lobach DF, Braun IM, Halpenny B, Rabin MS, Johns E, Finn K, Berry D, McCorkle R, Abrahm JL. Clinical Decision Support for Symptom Management in Lung Cancer Patients: A Group RCT. J Pain Symptom Manage 2022; 63:572-580. [PMID: 34921934 PMCID: PMC9194912 DOI: 10.1016/j.jpainsymman.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/19/2021] [Accepted: 12/07/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Clinical guidelines are available to enhance symptom management during cancer treatment but often are not used in the practice setting. Clinical decision support can facilitate the implementation and adherence to clinical guidelines. and improve the quality of cancer care. OBJECTIVES Clinical decision support offers an innovative approach to integrate guideline-based symptom management into oncology care. This study evaluated the effect of clinical decision support-based recommendations on clinical management of symptoms and health-related quality of life (HR-QOL) among outpatients with lung cancer. METHODS Twenty providers and 179 patients were allotted in group randomization to attention control (AC) or Symptom Assessment and Management Intervention (SAMI) arms. SAMI entailed patient-report of symptoms and delivery of recommendations to manage pain, fatigue, dyspnea, depression, and anxiety; AC entailed symptom reporting prior to the visit. Outcomes were collected at baseline, two, four and six-months. Adherence to recommendations was assessed through masked chart review. HR-QOL was measured by the Functional Assessment of Cancer Therapy-Lung questionnaire. Descriptive statistics with linear and logistic regression accounting for the clustering structure of the design and a modified chi-square test were used for analyses. RESULTS Median age of patients was 63 years, 58% female, 88% white, and 32% ≤high school education. Significant differences in clinical management were evident in SAMI vs. AC for all target symptoms that passed threshold. Patients in SAMI were more likely to receive sustained-release opioids for constant pain, adjuvant medications for neuropathic pain, opioids for dyspnea, stimulants for fatigue and mental health referrals for anxiety. However, there were no statistically significant differences in HR-QOL at any time point. CONCLUSION SAMI improved clinical management for all target symptoms but did not improve patient outcomes. A larger study is warranted to evaluate effectiveness.
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Affiliation(s)
- Mary E Cooley
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
| | - Emanuele Mazzola
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Niya Xiong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fangxin Hong
- Data Sciences (E.M., N.X., F.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | | | - Ilana M Braun
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barbara Halpenny
- Research in Nursing and Patient Care (M.E.C, B.H.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael S Rabin
- Lowe Center for Thoracic Oncology (M.S.R.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ellis Johns
- Family Medicine (E.J.), Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kathleen Finn
- Clinical Research (K.F.), City of Hope, Duarte, California, USA
| | - Donna Berry
- Biobehavioral Nursing and Health Informatics (D.B.), University of Washington, Seattle, Washington, USA
| | - Ruth McCorkle
- School of Nursing (R.M.), Yale University, New Haven, Connecticut, USA
| | - Janet L Abrahm
- Psychosocial Oncology and Palliative Care (I.M.B., J.L.A.), Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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13
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Hahn EE, Munoz-Plaza CE, Pounds D, Lyons LJ, Lee JS, Shen E, Hong BD, La Cava S, Brasfield FM, Durna LN, Kwan KW, Beard DB, Ferreira A, Padmanabhan A, Gould MK. Effect of a Community-Based Medical Oncology Depression Screening Program on Behavioral Health Referrals Among Patients With Breast Cancer: A Randomized Clinical Trial. JAMA 2022; 327:41-49. [PMID: 34982119 PMCID: PMC8728610 DOI: 10.1001/jama.2021.22596] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/01/2021] [Indexed: 12/20/2022]
Abstract
Importance Implementation of guideline-recommended depression screening in medical oncology remains challenging. Evidence suggests that multicomponent care pathways with algorithm-based referral and management are effective, yet implementation of sustainable programs remains limited and implementation-science guided approaches are understudied. Objective To evaluate the effectiveness of an implementation-strategy guided depression screening program for patients with breast cancer in a community setting. Design, Setting, and Participants A pragmatic cluster randomized clinical trial conducted within Kaiser Permanente Southern California (KPSC). The trial included 6 medical centers and 1436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018. Patients were followed up through study end date of May 31, 2019. Interventions Six medical centers in Southern California participated and were randomized 1:1 to tailored implementation strategies (intervention, 3 sites, n = 744 patients) or education-only (control, 3 sites, n = 692 patients) groups. The program consisted of screening with the 9-item Patient Health Questionnaire (PHQ-9) and algorithm-based scoring and referral to behavioral health services based on low, moderate, or high score. Clinical teams at tailored intervention sites received program education, audit, and feedback of performance data and implementation facilitation, and clinical workflows were adapted to suit local context. Education-only controls sites received program education. Main Outcomes and Measures The primary outcome was percent of eligible patients screened and referred (based on PHQ-9 score) at intervention vs control groups measured at the patient level. Secondary outcomes included outpatient health care utilization for behavioral health, primary care, oncology, urgent care, and emergency department. Results All 1436 eligible patients were randomized at the center level (mean age, 61.5 years; 99% women; 18% Asian, 17% Black, 26% Hispanic, and 37% White) and were followed up to the end of the study, insurance disenrollment, or death. Groups were similar in demographic and tumor characteristics. For the primary outcome, 7.9% (59 of 744) of patients at tailored sites were referred compared with 0.1% (1 of 692) at education-only sites (difference, 7.8%; 95% CI, 5.8%-9.8%). Referrals to a behavioral health clinician were completed by 44 of 59 patients treated at the intervention sites (75%) intervention sites vs 1 of 1 patient at the education-only sites (100%). In adjusted models patients at tailored sites had significantly fewer outpatient visits in medical oncology (rate ratio, 0.86; 95% CI, 0.86-0.89; P = .001), and no significant difference in utilization of primary care, urgent care, and emergency department visits. Conclusions and Relevance Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program. Trial Registration ClinicalTrials.gov Identifier: NCT02941614.
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Affiliation(s)
- Erin E. Hahn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | | | - Dana Pounds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
- Now with Southern California Permanente Medical Group Performance Assessment team, Pasadena
| | - Lindsay Joe Lyons
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Janet S. Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Benjamin D. Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | - Farah M. Brasfield
- Department of Medical Oncology, Southern California Permanente Medical Group, Anaheim
| | - Lara N. Durna
- Department of Medical Oncology, Southern California Permanente Medical Group, South Bay
| | - Karen W. Kwan
- Department of Medical Oncology, Southern California Permanente Medical Group, Los Angeles
| | - David B. Beard
- Department of Medical Oncology, Southern California Permanente Medical Group, Woodland Hills
| | - Alexander Ferreira
- Department of Medical Oncology, Southern California Permanente Medical Group, West Los Angeles
| | - Aswini Padmanabhan
- Department of Medical Oncology, Southern California Permanente Medical Group, Baldwin Park
| | - Michael K. Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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14
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Screening for distress in cancer care: How to overcome barriers after unsuccessful implementation? Palliat Support Care 2021; 20:1-3. [PMID: 34809730 DOI: 10.1017/s1478951521001759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Deshields TL, Wells-Di Gregorio S, Flowers SR, Irwin KE, Nipp R, Padgett L, Zebrack B. Addressing distress management challenges: Recommendations from the consensus panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work. CA Cancer J Clin 2021; 71:407-436. [PMID: 34028809 DOI: 10.3322/caac.21672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients' quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization-inner setting (the context of the clinic, hospital, or health care system); and 5) organization-outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges.
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Affiliation(s)
- Teresa L Deshields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois
| | - Sharla Wells-Di Gregorio
- Department of Internal Medicine, Division of Palliative Medicine, The Ohio State University Wexner Medical Center, James Cancer Hospital, Columbus, Ohio
| | - Stacy R Flowers
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lynne Padgett
- Department of Psychology, Veterans Affairs Medical Center, Washington, District of Columbia
| | - Brad Zebrack
- School of Social Work, University of Michigan, Ann Arbor, Michigan
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Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies. Curr Opin Support Palliat Care 2021; 14:220-231. [PMID: 32657813 DOI: 10.1097/spc.0000000000000513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services. RECENT FINDINGS Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies. SUMMARY Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.
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Hardardottir H, Aspelund T, Zhu J, Fall K, Hauksdottir A, Fang F, Lu D, Janson C, Jonsson S, Valdimarsdottir H, Valdimarsdottir UA. Optimal communication associated with lower risk of acute traumatic stress after lung cancer diagnosis. Support Care Cancer 2021; 30:259-269. [PMID: 34273032 DOI: 10.1007/s00520-021-06138-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/04/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to assess the role of the patient's background and perceived healthcare-related factors in symptoms of acute stress after lung cancer diagnosis. METHODS The study population consisted of 89 individuals referred for diagnostic work-up at Landspitali National University Hospital in Iceland and subsequently diagnosed with lung cancer. Before diagnosis, the patients completed questionnaires on sociodemographic characteristics, pre-diagnostic distress (Hospital Anxiety and Depression Scale), social support, and resilience. At a median of 16 days after diagnosis, the patients reported symptoms of acute stress on the Impact of Event Scale-Revised (IES-R) and experience of communication and support from healthcare professionals and family during the diagnostic period. RESULTS Patients were on average 68 years and 52% reported high levels of post-diagnostic acute stress (IES-R > 23) while 24% reported symptoms suggestive of clinical significance (IES-R > 32). Prior history of cancer (β = 6.7, 95% CI: 0.1 to 13.3) and pre-diagnostic distress were associated with higher levels of post-diagnostic acute stress (β = 8.8, 95% CI: 2.7 to 14.9), while high educational level (β = - 7.9, 95% CI: - 14.8 to - 1.1) was associated with lower levels. Controlling for the abovementioned factors, the patients' perception of optimal doctor-patient (β = - 9.1, 95% CI: - 14.9 to - 3.3) and family communication (β = - 8.6, 95% CI: - 14.3 to - 2.9) was inversely associated with levels of post-diagnostic acute stress after lung cancer diagnosis. CONCLUSIONS A high proportion of patients with newly diagnosed lung cancer experience high levels of acute traumatic stress of potential clinical significance. Efforts to improve doctor-patient and family communication may mitigate the risk of these adverse symptoms.
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Affiliation(s)
- Hronn Hardardottir
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland. .,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jianwei Zhu
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Arna Hauksdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Donghao Lu
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christer Janson
- Respiratory, Allergy and Sleep Research, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Steinn Jonsson
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland.,Department of Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Heiddis Valdimarsdottir
- Department of Psychology, Reykjavík University, Reykjavik, Iceland.,Mount Sinai School of Medicine, New York, NY, USA
| | - Unnur A Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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18
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Partnering with healthcare facilities to understand psychosocial distress screening practices among cancer survivors: pilot study implications for study design, recruitment, and data collection. BMC Health Serv Res 2021; 21:238. [PMID: 33731095 PMCID: PMC7968218 DOI: 10.1186/s12913-021-06250-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to understand barriers and facilitators to implementing distress screening (DS) of cancer patients to inform and promote uptake in cancer treatment facilities. We describe the recruitment and data collection challenges and recommendations for assessing DS in oncology treatment facilities. METHODS We recruited CoC-accredited facilities and collected data from each facility's electronic health record (EHR). Collected data included cancer diagnosis and demographics, details on DS, and other relevant patient health data. Data were collected by external study staff who were given access to the facility's EHR system, or by facility staff working locally within their own EHR system. Analyses are based on a pilot study of 9 facilities. RESULTS Challenges stemmed from being a multi-facility-based study and local institutional review board (IRB) approval, facility review and approval processes, and issues associated with EHR systems and the lack of DS data standards. Facilities that provided study staff remote-access took longer for recruitment; facilities that performed their own extraction/abstraction took longer to complete data collection. CONCLUSION Examining DS practices and follow-up among cancer survivors necessitated recruiting and working directly with multiple healthcare systems and facilities. There were a number of lessons learned related to recruitment, enrollment, and data collection. Using the facilitators described in this manuscript offers increased potential for working successfully with various cancer centers and insight into partnering with facilities collecting non-standardized DS clinical data.
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Götz A, Kröner A, Jenewein J, Spirig R. Wie erleben und beurteilen Pflegende das Screening von stationären onkologischen Patient_innen mit dem Belastungsthermometer? Pflege 2021; 34:71-79. [PMID: 33535833 DOI: 10.1024/1012-5302/a000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Anna Götz
- Comprehensive Cancer Center Zürich, Universitätsspital Zürich.,PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke
| | | | - Josef Jenewein
- Triaplus Ag - Integrierte Psychiatrie Uri, Schwyz und Zug
| | - Rebecca Spirig
- PhD Programm, Department für Pflegewissenschaft, Universität Witten / Herdecke.,Institut für Pflegewissenschaft, Universität Basel
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20
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CancerSupportSource®-15+: development and evaluation of a short form of a distress screening program for cancer patients and survivors. Support Care Cancer 2021; 29:4413-4421. [PMID: 33447863 PMCID: PMC8236438 DOI: 10.1007/s00520-021-05988-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
Purpose CancerSupportSource® (CSS) is a distress screening program implemented at community-based organizations and hospitals nationwide. The 25-item CSS assesses distress across five domains, with capacity to screen for clinically significant depression and anxiety. This study examined psychometric properties of a shortened form to enhance screening opportunities when staff or patient burden considerations are significant. Methods Development and validation were completed in multiple phases. Item reduction decisions were made with 1436 cancer patients by assessing external/internal item quality and judging theoretical and practical implications of items. Pearson correlations and confirmatory factor analysis were conducted on a separate sample of 957 patients to corroborate psychometric properties and dimensionality of the shortened scale. Nonparametric receiver operating characteristic (ROC) curve analyses determined scoring thresholds for depression and anxiety risk scales. Results Scale refinement resulted in a 15-item short form plus one screening item assessing tobacco and substance use (CSS-15+). At least two items from each CSS domain were retained to preserve multidimensionality. In confirmatory analysis, the model explained 59% of the variance and demonstrated good fit. Correlation between CSS-15+ and 25-item CSS was 0.99, p < 0.001. Sensitivity of 2-item depression and 2-item anxiety risk scales in the confirmatory sample were 0.82 and 0.83, respectively. Conclusions CSS-15+ is a brief, reliable, and valid multidimensional measure of distress. The measure retained excellent internal consistency (α = 0.94) and a stable factor structure. CSS-15+ is a practical and efficient screening tool for distress and risk for depression and anxiety among cancer patients and survivors, particularly in community-based settings.
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21
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Dekker J, Karchoud J, Braamse AMJ, Buiting H, Konings IRHM, van Linde ME, Schuurhuizen CSEW, Sprangers MAG, Beekman ATF, Verheul HMW. Clinical management of emotions in patients with cancer: introducing the approach "emotional support and case finding". Transl Behav Med 2020; 10:1399-1405. [PMID: 33200793 PMCID: PMC7796719 DOI: 10.1093/tbm/ibaa115] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The current approach to the management of emotions in patients with cancer is “distress screening and referral for the provision of psychosocial care.” Although this approach may have certain beneficial effects, screening and referral programs have shown a limited effect on patient psychological well-being. We argue that this limited effect is due to a mismatch between patient needs and the provision of care, and that a fundamental reconceptualization of the clinical management of emotions in patients with cancer is needed. We describe the rationale and characteristics of “emotional support and case finding” as the approach to the management of emotions in patients with cancer. The two main principles of the approach are: (1) Emotional support: (a) The treating team, consisting of doctors, nurses, and allied health staff, is responsive to the emotional needs of patients with cancer and provides emotional support. (b) The treating team provides information on external sources of emotional support. (2) Case finding: The treating team identifies patients in need of mental health care by means of case finding, and provides a referral to mental health care as indicated. We present a novel perspective on how to organize the clinical management of emotions in patients with cancer. This is intended to contribute to a fruitful discussion and to inform an innovative research agenda on how to manage emotions in patients with cancer.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Jeanet Karchoud
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Hilde Buiting
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Inge R H M Konings
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Myra E van Linde
- Department of Medical Oncology, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | | | - Mirjam A G Sprangers
- Department of Medical Psychology, Amsterdam University Medical Centers (location AMC), Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam University Medical Centers (location VUmc), Amsterdam, the Netherlands
| | - Henk M W Verheul
- Department of Medical Oncology, Radboud UMC, Nijmegen, the Netherlands
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22
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Dekker J, Graves KD, Badger TA, Diefenbach MA. Management of Distress in Patients with Cancer-Are We Doing the Right Thing? Ann Behav Med 2020; 54:978-984. [PMID: 33416842 PMCID: PMC7791612 DOI: 10.1093/abm/kaaa091] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Screening for distress and referral for the provision of psychosocial care is currently the preferred approach to the management of distress in patients with cancer. To date, this approach has shown a limited effect on the reduction of distress. Recent commentaries have argued that the implementation of distress screening should be improved. On the other hand, the underlying assumption that a referral for psychosocial care is required for distressed patients can be questioned. This has led to the development of an alternative approach, called emotional support and case finding. PURPOSE In the context of finding innovative solutions to tomorrow's health challenges, we explore ways to optimize distress management in patients with cancer. METHODS AND RESULTS We discuss three different approaches: (i) optimization of screening and referral, (ii) provision of emotional support and case finding, and (iii) a hybrid approach with multiple assessments, using mobile technology. CONCLUSIONS We suggest continued research on the screening and referral approach, to broaden the evidence-base on improving emotional support and case finding, and to evaluate the utility of multiple assessments of distress with new interactive mobile tools. Lessons learned from these efforts can be applied to other disease areas, such as cardiovascular disease or diabetes.
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Affiliation(s)
- Joost Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Kristi D Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Terry A Badger
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Michael A Diefenbach
- Institute for Clinical Outcomes Research (iCOR), Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
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23
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Kayser K, Brydon DM, Moon H, Zebrack B. Institutional capacity to provide psychosocial care in cancer programs: Addressing barriers to delivering quality cancer care. Psychooncology 2020; 29:1995-2002. [DOI: 10.1002/pon.5488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/16/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Karen Kayser
- Kent School of Social Work University of Louisville Louisville Kentucky USA
| | - Daphne M. Brydon
- School of Social Work University of Michigan Ann Arbor Michigan USA
| | - Heehyul Moon
- Kent School of Social Work University of Louisville Louisville Kentucky USA
| | - Brad Zebrack
- School of Social Work University of Michigan Ann Arbor Michigan USA
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24
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Hesse BW, Ahern D, Ellison M, Aronoff-Spencer E, Vanderpool RC, Onyeije K, Gibbons MC, Mullett TW, Chih MY, Attencio V, Patterson G, Boten J, Hartshorn C, Bartolome B, Gorscak K, McComsey M, Hubenko A, Huang B, Baker C, Norman D. Barn-Raising on the Digital Frontier: The L.A.U.N.C.H. Collaborative. JOURNAL OF APPALACHIAN HEALTH 2020; 2:6-20. [PMID: 35769536 PMCID: PMC9138843 DOI: 10.13023/jah.0201.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A meta-analysis of oncology papers from around the world revealed that cancer patients who lived more than 50 miles away from hospital centers routinely presented with more advanced stages of disease at diagnosis, exhibited lower adherence to prescribed treatments, presented with poorer diagnoses, and reported a lower quality of life than patients who lived nearer to care facilities. Connected health approaches-or the use of broadband and telecommunications technologies to evaluate, diagnose, and monitor patients beyond the clinic-are becoming an indispensable tool in medicine to overcome the obstacle of distance.
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Abstract
Given the high prevalence (30-35%) of psychosocial and psychiatric morbidity amongst cancer patients in any phase of the disease trajectory, screening for emotional problems and disorders has become mandatory in oncology. As a process, screening begins at the entry to the cancer care system and continues at clinically meaningful times, periodically during active cancer care, or when clinically indicated. The goal is to facilitate proper referral to psychosocial oncology specialists for more specific assessment and care, as well as treatment and evaluation of the response, according to the implementation of distress management guidelines. In this editorial, we will provide a non-exhaustive overview of relevant protocols, with particular reference to the National Comprehensive Cancer Network (NCCN) Distress Management in Oncology Guidelines, and review the challenges and the problems in implementing screening, and the assessment and management of psychosocial and psychiatric problems in cancer centres and community care.
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26
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An implementation science primer for psycho-oncology: translating robust evidence into practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/or9.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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