Shannon L. Groff

Screening for Distress in Lung and Breast Cancer Outpatients: A Randomized Controlled Trial

PURPOSE Distress has been recognized as the sixth vital sign in cancer care and several guidelines recommend routine screening. Despite this, screening for distress is rarely conducted and infrequently evaluated. METHODS A program of routine online screening for distress was implemented for new patients with breast and lung cancer. Patients were randomly assigned to one of three conditions: (1) minimal screening: the distress thermometer (DT) only plus usual care; (2) full screening: DT, problem checklist, Psychological Screen for Cancer part C measuring anxiety and depression, a personalized report summarizing concerns and the report on the medical file; or (3) triage: full screening plus optional personalized phone triage with referral to resources. Patients in all conditions received an information packet and were reassessed 3 months later with the full screening battery. RESULTS Five hundred eighty-five patients with breast cancer and 549 patients with lung cancer were assessed at baseline (89% of all patients), and 75.5% retained for follow-up. High prevalence of baseline distress was found across patients. Twenty percent fewer patients with lung cancer in triage continued to have high distress at follow-up compared to those in the other two groups, and patients with breast cancer in the full screening and triage conditions showed lower distress at follow-up than those in minimal screening. The best predictor of decreased anxiety and depression in full screening and triage conditions was receiving a referral to psychosocial services. CONCLUSION Routine online screening is feasible in a large cancer center and may help to reduce future distress levels, particularly when coupled with uptake of appropriate resources.

Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice†

Objective: Distress is prevalent among cancer patients at all stages of illness and has been endorsed as the 6th Vital Sign in cancer care. Despite its prevalence, and calls to be monitored, few cancer programs are Screening for Distress in a standardized manner. In this paper, the implementation strategy employed in Canada to change practice by integrating Screening for Distress in routine care is described.

Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage

Background:This randomised controlled trial examined the impact of screening for distress followed by two different triage methods on clinically relevant outcomes over a 12-month period.Methods:Newly diagnosed patients attending a large tertiary cancer centre were randomised to one of the two conditions: (1) screening with computerised triage or (2) screening with personalised triage, both following standardised clinical triage algorithms. Patients completed the Distress Thermometer, Pain and Fatigue Thermometers, the Psychological Screen for Cancer (PSSCAN) Part C and questions on resource utilisation at baseline, 3, 6 and 12 months.Results:In all, 3133 patients provided baseline data (67% of new patients); with 1709 (54.5%) retained at 12 months (15.4% deceased). Mixed effects models revealed that both groups experienced significant decreases in distress, anxiety, depression, pain and fatigue over time. People receiving personalised triage and people reporting higher symptom burden were more likely to access services, which was subsequently related to greater decreases in distress, anxiety and depression. Women may benefit more from personalised triage, whereas men may benefit more from a computerised triage model.Conclusion:Screening for distress is a viable intervention that has the potential to decrease symptom burden up to 12 months post diagnosis. The best model of screening may be to incorporate personalised triage for patients indicating high levels of depression and anxiety while providing computerised triage for others.

Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex, and age

BackgroundVery few studies examine the longitudinal prevalence of problems and the awareness or use of clinical programs by patients who report these problems. Of the studies that examine age, gender and marital status as predictors of a range of patient outcomes, none examines the interactions between these demographic variables. This study examined the typical trajectory of common practical and psychosocial problems endorsed over 12 months in a usual-care sample of cancer outpatients. Specifically, we examined whether marital status, sex, age, and their interactions predicted these trajectories. We did not actively triage or refer patients in this study in order to examine the natural course of problem reports.MethodsPatients completed baseline screening (N = 1196 of 1707 approached) and the sample included more men (N = 696) than women (N = 498), average age 61.1 years. The most common diagnoses were gastrointestinal (27.1%), prostate (19.2%), skin (11.1%) and gynecological (9.2%). Among other measures, patients completed a Common Problem Checklist and Psychosocial Resources Use questions at baseline, 3, 6, and 12 months using paper and pencil surveys.ResultsResults indicated that patients reported psychosocial problems more often than practical and both decreased significantly over time. Younger single patients reported more practical problems than those in committed relationships. Younger patients and women of all ages reported more psychosocial problems. Among a number of interesting interactions, for practical problems, single older patients improved more; whereas among married people, younger patients improved more. For psychosocial problems we found that older female patients improved more than younger females, but among males, it was younger patients who improved more. Young single men and women reported the most past-and future-use of services.ConclusionsYounger women are particularly vulnerable to experiencing practical and psychosocial problems when diagnosed with cancer, but being married protects these younger women. Marriage appeared to buffer reports of both practical and psychosocial problems, and led to less awareness and use of services. Unexpectedly, young men reported the highest use of psychosocial services. This study informs clinical program development with information on these risk groups.

Screening for distress, the sixth vital sign: examining self-referral in people with cancer over a one-year period

Although research has indicated a diagnosis of cancer is most often distressing for patients and their families, few studies have examined which patients access resources to manage distress or how distress levels affect resource utilization. This study explored psychosocial and supportive care resource utilization in a large cancer population at a Canadian tertiary cancer centre over a 12‐month period in a usual care setting.

Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems—secondary outcomes of a randomized controlled trial

This randomized controlled trial examined the impact of an online routine screening for distress program on physical symptoms and common psychosocial and practical problems in lung cancer outpatients.

Patient ethnicity: a key predictor of cancer care satisfaction

Introduction. Research in cancer care satisfaction itself is scarce; investigation of the role of ethnicity in care satisfaction is even rarer. Objective. The present study examined relationships between ethnicity and satisfaction with care in a sample of 759 patients diagnosed with three different types of cancer (lung, head and neck, or gynecologic) from a large tertiary cancer hospital. Method. Respondents filled out an assessment package that consisted of demographics, the Ware Patient Satisfaction Questionnaire-III (PSQ-III), 17 additional items constructed by the research team to examine other specific areas of satisfaction, and the Psychological Screen for Cancer (PSSCAN) Part C, to measure anxiety and depression. Results. In a multivariate analysis, being non-White emerged as the primary predictor variable (beyond patient age, gender, marital status, education, cancer site, duration of illness, and presence or absence of metastases) of several of the PSQ-III satisfaction subscales. Conclusion. Health care systems must consider how to become more responsive to the needs of all individuals, regardless of their ethnic background and levels of acculturation.

Risk Factors for Continuous Distress Over a 12-Month Period in Newly Diagnosed Cancer Outpatients

This analysis examined demographic and medical factors associated with continuous distress in the year following cancer diagnosis. Patients completed the Distress Thermometer, Fatigue and Pain Thermometers, and anxiety and depression measures, at baseline, 3-, 6-, and 12 months. A total of 480 patients were grouped into three trajectories for distress, pain, fatigue, anxiety, and depression. Logistic regression analyses were conducted to determine risk factors associated with each symptom pattern. Females were more likely to report continuous distress. Predictors of the remaining outcomes included younger age; a diagnosis of head and neck, gastrointestinal, or prostate cancer; and receipt of chemotherapy and radiation therapy. By identifying risk factors for continuous distress, interventions can be implemented more efficiently and targeted to those who are at an elevated risk.

Cancer Patientsʼ Satisfaction With Care in Traditional and Innovative Ambulatory Oncology Clinics

This study examined the effects of environmental changes, such as rearranging the seating area, playing soft music, and displaying scenes of nature, on aspects of patient satisfaction, ranging from satisfaction with the physical environment and wait times to continuity of care, confidentiality, and trust in providers. Patients receiving care in a new, innovative cancer center had significantly higher satisfaction scores on the physical environment and wait time subscales than the patients receiving care in an older, traditional center. However, the 2 centers did not differ on any of the other satisfaction subscales. Implications of these findings are discussed.

Characterizing distress, the 6th vital sign, in an oncology pain clinic

CONTEXT The delineation of populations of cancer patients with complex symptoms can inform the planning and delivery of supportive care services. OBJECTIVES We explored the physical, psychosocial, and practical concerns experienced by patients attending an ambulatory oncology symptom control clinic. METHODS Patients attending a Pain Clinic at a large tertiary cancer centre were invited to complete screening measures assessing distress, pain, fatigue, anxiety, depression, and practical and psychosocial problems. A matched sample of patients who did not attend the Pain Clinic were selected as a comparison group. RESULTS Of all eligible Pain Clinic patients, 46 (77%) completed the measures; so did 46 comparison group patients. The percentages of patients reporting distress (78.3%), pain (93.5%), and fatigue (93.5%) were higher among Pain Clinic patients than among the comparison patients. A higher percentage of Pain Clinic patients also reported multiple, severe, concurrent symptoms: 87% scored 7 or higher in at least one of the pain, fatigue, or distress scales, and 30.4% of the patients scored 7 or higher on all three. The most common problem areas were feeling a burden to others, trouble talking with friends and family, spirituality, and sleep difficulties. CONCLUSIONS Higher levels of multiple, concurrent symptoms and psychosocial problems were found in Pain Clinic patients than in a group of patients who did not attend the Pain Clinic. Routine screening and triaging of cancer patients using a comprehensive and standardized panel of questions can facilitate symptom assessment and management, and can inform program planning.