Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression

1. 0178 --Implementation of aaScreening Programme for Cancer
0178 Implementation of Screening Programme for Cancer
Related Distress: Part II --Does Screening Aid Clinicians’
Related Distress: Part II Does Screening Aid Clinicians’
Communication, Judgement or Accuracy of Anxiety and Depression?
Communication, Judgement or Accuracy of Anxiety and Depression?
Alex Mitchell www.psycho-oncology.info
Paul Symonds
Lorraine Grainger
Elena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010
IPOS 2010

2. Concepts of Implementation
Staff Recognition (unassisted) Baseline
Tool Validity (vs gold standard)
Pilot tool
Tool acceptability
Detection
Before tool
Clinician management
Patient wellbeing
Detection
Clinician management
Patient wellbeing After tool

3. Audit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention

4. Phase I

5. Phase II

6. Phase II

7. DepT
DT
23%
37%
4% 3%
3%
DT DepT
7% 1%
Non-Nil 8% 0% Nil
9%
59% 41%
4% 1%
AnxT 2% AngT
15% 2%
AnxT AngT
47% 18%

8. More than just “distress”
Of 401 chemotherapy attendees
59% have an emotional complication (3v4)
37% (62% of 59%) it included distress
23% it excluded distress
Validity of DT vs depression (DSMIV)
SE 80% SP 60% PPV 32% NPV 93%

9. Local Study: Recognition by CNS in oncology
Approached - 800 patients
Willing - 700
Assessed - 500
Returned - 402

10. Phase II Results – detection baseline

11. 100.0
5.9
11.1
14.3
90.0 Comment: Slide illustrates diagnostic 21.4
accuracy according to score on DT 11.8
25.9
80.0 38.7 38.1
43.5 22.2 14.3
46.7
70.0 59.6
21.4
72.4
60.0 Judgement = Non-distressed
33.3 Judgement = Unclear
19.4 19.0 Judgement = Distressed
50.0
26.1
40.0 24.4 82.4
71.4
66.7
30.0
25.0 57.1
41.9 42.9 40.7
20.0 15.8
30.4 28.9
10.0
15.4
11.8
0.0
Zero One Two Three Four Five Six Seven Eight Nine Ten

12. Phase II Results Post ET (DT)
1. Does tool influence detections?
2. Does tool influence quality of care?

13. Graphical – Screening principles
#
of Cut-Off
Individuals
Low High
Non-Depressed
<<<< low Specificity
Severity of Depression
High Sensitivity >>>> Depressed
#
of
Individuals

14. Pre Screen – Ability of Clinicians to Detect
Before
Sensitivity Distress 49.7%
Sensitivity Depression 55.4%
Sensitivity Anxiety 41.7%
Sensitivity Anxiety or Dep 41.7%

15. Ability of Clinicians to Detect Healthy
Before
Specificity Distress 79.3%
Specificity Depression 87.5%
Specificity Anxiety 81.9%
Specificity Anxiety or Dep 80.5%

16. Pre-Post Screen – Change?
Before After
Change distress =>+5%
Change depression =>+3%
Change anxiety =>+4%

17. Qualitative benefits
DEPRESSION
38% of occasions reported useful in improving communication.
28.6% useful for informing clinical judgement

18. FURTHER READING:
Screening for Depression in Clinical Practice An
Evidence-Based guide
ISBN 0195380193
Paperback, 416 pages
Nov 2009
Price: £39.99