Talk from IPOS2010

1. 680 --Implementation of a Screening Programme for
680 Implementation of a Screening Programme for
Cancer Related Distress: Part III –
Cancer Related Distress: Part III –
Does Screening Aid Clinicians’ Quality of Care?
Does Screening Aid Clinicians’ Quality of Care?
Alex Mitchell www.psycho-oncology.info
Paul Symonds
Lorraine Grainger
Elena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS2010

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. Defining Quality of Care

4. Defining Quality of Care
Clinician takes appropriate action
Unmet needs are met
Meetable unmet needs are met, by clinician without delay

5. Leicester: DT/ET Implementation T177 t680
800 Patients Approached
100 Not Willing (13%) 700 Patients Willing (87%)
TAU 500 Staff Willing (71%)
Screen Data 402 Data Collected (80%)
Detections before Detections after Care after

6. Phase II

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

8. Interim
269 Nurse-patient
interactions
Helped 65 (24%) Not Helped 204 (76%)
Referred 23 (8.6%) Declined Helped 20 (7.4%)
No Unmet Needs 34 (12.6%)
Unmet Needs 150 (55.8%)
p179

9. Overall clinician care
Of 402 nurse-patient interactions:
no action was taken in 62% (of which 10% patients
declined)
patient were helped in 38% of consultations.
Of those helped, a referral was made in 25.9% of cases
(10% overall)

10. Clinician Care by Patient distress
Of 183 who screened positive for distress 108 (59%)
were helped
Of 219 without distress, 44 (20%) were offered help
(Chi² = 14 P < 0.001).

11. Clinician Care by Patient Depression
Of 70 who screened positive for depression 28 (38.6%)
were helped
Of 219 without depression, 48 (22%) were offered help
(Chi² = 14 P < 0.001).

12. 2x2 Clinician Help Table : by Diagnosis
Diagnosis Yes Diagnosis No
Distress 59% helped 20% helped
Anxiety 33% helped 17.5% helped
Depression 39% helped 22% helped
Anger 30% helped 24% helped
Any 46% helped 20% helped

13. Effect of Screening…more than distress
Screening influences -
Clarification of patient distress
Clarification of clinician opinion
Clarification of unmet needs
Clarification of desire for help

14. 2x2 Clinician Help Table : ACTUAL HELP
Clinician thinks: Clinician thinks no
Unmet Needs Unmet Needs
Patient Says: => Intervention => Low grade
Help Wanted
Patient Distressed => Intervention =>??
Patient Not => Monitor? => discharge?
distressed or
Help Not Wanted

15. Clinician help combined
In those with patient reported distress + clinician
evaluated distress 22/65 (33.8%) were offered help
and 16% offered referral.
In those with neither patient reported nor clinician
evaluated distress 10/90 (11.1%) were offered help
and 2% offered referral.
In those with patient reported distress + clinician
evaluated distress + also wanted help 56% were
helped

16. 2x2 Clinician Help Table : ACTUAL HELP
Clinician thinks: Clinician thinks
Unmet Needs no Unmet Needs
Patient Says: Helped 21/35 Helped 11/23
Help Wanted
Patient Helped 65/102 Helped 31/62
Distressed
Patient Not Helped 8/35 Helped 20/117
distressed or
Help Not Wanted

17. Phase III
Radiotherapy screen implementation
– RCT of screen + intervention

19. Credits & Acknowledgments
Elena Baker-Glenn University of Nottingham
Paul Symonds Leicester Royal Infirmary
Chris Coggan Leicester General Hospital
Burt Park University of Nottingham
Lorraine Granger Leicester Royal Infirmary
James Coyne University of Pennsylvania
Nadia Husain Leicester General Hospital
Joanne Herdman Leicester General Hospital
Jo Kavanagh Leicester Royal Infirmary
For more information www.psycho-oncology.info