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 T177 - Implementation of a Screening Programme for Cancer Related Distress: Part I - Does Screening Influence Detection of Distress?
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IPOS10 T177- Implementation of a Screening Programme for Cancer Related Distress: Part I - Does Screening Influence Detection of Distress
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Alex Mitchell www.psycho-oncology.infoPaul SymondsLorraine GraingerElena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010IPOS 2010
T177 - Implementation of a Screening Programme for Cancer Related Distress:
Part I - Does Screening Influence Detection of Distress?
T177 - Implementation of a Screening Programme for Cancer Related Distress:
Part I - Does Screening Influence Detection of Distress?
Concepts of ImplementationConcepts of Implementation
Staff Recognition (unassisted)
Tool Validity (vs gold standard)
Tool acceptability
DetectionClinician managementPatient wellbeing
Before tool
After tool
Pilot tool
Baseline
Audit / Research ProtocolAudit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention
Phase I
Phase II
Phase II
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
DistressThermometer
AnxietyThermometer
DepressionThermometer
AngerThermometer
TenNineEightSevenSixFiveFourThreeTwoOneZero
Comment: Slide illustrates scores on ET tool
8%
DT37%
DepT23%
AngT18%
AnxT47%
4%
7%
1%
1%
9%
3%
0%
2%
4%
15%
3%
2%
Nil41%
Non-Nil59%
DT
AnxT AngT
DepT
More than just “distress”More than just “distress”
There was a non-significant trend for improve detection sensitivity (Chi² = 1.12 P = 0.29).
Screening a failure?Screening a failure?
Clover, Carter et al (unpublished)
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8Quarter of screening
% p
atie
nts
over
thre
shol
d Distress
Pain
First occasion of screening (n=4543)
a. Communicationa. Communication
DISTRESS
43% of CNS reported the tool helped them talk with the patient about psychosocial issues esp in those with distress
28% said it helped inform their clinical judgement
DEPRESSION
38% of occasions reported useful in improving communication.
28.6% useful for informing clinical judgement
Credits & Acknowledgments
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal InfirmaryJames Coyne University of PennsylvaniaNadia Husain Leicester General HospitalJoanne Herdman Leicester General HospitalJo Kavanagh Leicester Royal Infirmary