Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Distress Screening & Management in Cancer Deidre B. Pereira, PhD Associate Professor Licensed Psychologist Psychosocial Rep., UFHCC Joint Oncology Program Department of Clinical & Health Psychology College of Public Health & Health Professions Definition of Distress in Cancer: NCCN Distress Management Guidelines Version 2.2014 An unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social, and/or spiritual nature Multifactorial Interferes with the ability to manage cancer Exists on a continuum: – Common feelings of sadness and fear – Disabling panic, depression, anger Distress Screening Requirement American College of Surgeons (ACoS) Commission on Cancer (CoC) 2012 Cancer Program Standards Hospital Cancer Committee must develop and implement a process to integrate and monitor onsite psychosocial distress screening and referral for treatment as standard of care Overseen by psychosocial representative on cancer committee Method of assessment can be determined by the program CoC Requirements Assessed at least once during a pivotal medical visit Preference for assessment methods that are standardized, validated, and have clinical cut-offs Individuals with moderate/severe distress must be referred to appropriate resources for management Assessment, referral, follow-up must be documented in the medical record Distress as the 6th Vital Sign (Howell & Olsen, 2011) Assessment of distress via Distress Thermometer or Visual Analog Scale (0 [No distress] – 10 [Worst distress imaginable] ) parallel to assessment of other vitals, such as temperature and pain Cancer-Related Distress & Disability Years Lost due to Disability in cancer: – 270 years per 100,000 population Clinically-significant distress: Epi research – 5.7% of cancer survivors – 4.3% of patients with other health conditions – 0.7% of healthy individuals Clinically-significant distress: Acute care – 31.3% of cancer patients, self-reported – 56.3% of cancer patients, expert-rated Distress Screening & Management: A Stepped Care Model Mental Health Assessment & Intervention Health & Behavior Assessment & Intervention Distress Screening Distress Screening Participants Oncology Nurse Navigators Psychiatry PsychoOncology Service PatientCentered Oncology Care Palliative Care & Symptom Management Oncology Social Work Integrative Medicine Health & Behavior Assessment/Intervention Participants Oncology Nurse Navigators PsychoOncology Service PatientCentered Oncology Care Palliative Care & Symptom Management Oncology Social Work Integrative Medicine Mental Health Assessment/Intervention Participants Oncology Social Work Psychiatry PatientCentered Oncology Care PsychoOncology Service Integrative Medicine Distress is an unpleasant emotional state that may affect how you feel, think, and act. It can include feelings of unease, sadness, worry, anger, helplessness, guilt, and so forth. It is common to feel sad, fearful, and helpless. Feeling distressed may be a minor problem or it may be more serious. You may be so distressed that you can't do the things you used to do. Serious or not, it is important that your treatment team knows how you feel. The Distress Thermometer is a tool that you can use to talk to your health care providers about your distress. It has a scale on which you circle your level of distress. It also asks about the parts of life in which you are having problems. The Distress Thermometer has been tested in many studies and found to work well. The Distress Thermometer and the other questions below will help your treatment team know if you need supportive services. You may be referred to supportive services at UF or in your community. Supportive services can include help from support groups, chaplains, social workers, mental health counselors, psychologists, or psychiatrists. Health & Behavior Assessment Components • • • • • Cancer History • • • • Primary diagnosis Date of diagnosis Type(s) of treatment completed to date Type(s) of treatment under consideration Dates and brief descriptions of any cancer-related inpatient hospitalizations to date Previous cancer diagnosis Medications and any side effects experienced Changes in quality of life due to cancer/cancer treatment (including pain) Other significant medical problems Mood Screening • • • • • • • • • • • • • • Sadness/Depressed mood Anhedonia Crying spells Fatigue/loss of energy Appetite disturbance Sleep disturbance Psychomotor agitation or retardation Irritability Feelings of guilt/worthlessness/hopelessness/helple ssness Changes in libido Suicidal ideation Homicidal ideation Anxiety Mania/hypomania Behavioral Screening Cognitive Screening • Current/past psychopharmacologic medications • Current/recent/past alcohol use • Current/recent/past tobacco use • Current/recent/past illicit substance use • • • • Getting lost in familiar places Misplacing belongings Inability to concentrate Short- or long-term memory impairments • Confusion or disorientation • • • • • Hallucinations Delusions Dissociation Depersonalization Unusual beliefs • Other current stressors • History of trauma • Main problem- and/or emotionfocused coping mechanisms used, including their efficacy Psychosis Screening Stress and Coping Screening • • • • • • • Brief Psychosocial History • Patient Health Questionnaire - 9 (PHQ9) Self-Report Testing Age Date and location of birth Location of current residence Education Marital status Number of children Brief description of quality of family (including spouse/partner) relationships • Employment status, including job satisfaction if employed • Hobbies, activities that bring enjoyment • Plans for the future Mental Health Assessment • Past/current depressive symptoms • Current hopelessness • Past/recent/current suicidal ideation, intent, plan, gestures, or behavior • Significant current, exacerbating stressors (including relational) • Past/current anxious symptoms • Trauma history • Significant previous stressors and effectiveness of skills used to cope with these • Past/current alcohol, tobacco, and illicit substance use • Patient's strengths • Nature of social support network • Cancer-related quality of life (e.g., pain, fatigue, nausea/vomiting, anorexia/cachexia, sleep, sexual functioning) • Cancer-related concerns (e.g., end of life concerns, body image concerns, fears of recurrence, thoughts about death, spiritual/religious crisis, sexuality/intimacy concerns, reproductive health/fertility concerns) Current Distress Screening & Management at UFHCC Routine Distress Screening – Multidisciplinary GI Oncology Clinic (2009 – Present) – Inpatient Medical Oncology (January 2015 Present) – Outpatient Medical Oncology (June 2015) – Outpatient Radiation Oncology (August 2015) Registration staff provides distress screening form to patient Patient completes form in waiting room Medical Assistant (MA) gathers form and enters data into “Vitals” in EHR If patient desires, referrals to Oncology Social Work and/or Psycho-Oncology Service provided HCP discusses results with patient and offers appropriate referrals If Distress Thermometer > 4 or PHQ-2 > 3, MA alerts HCP Oncology Social Work and Psycho-Oncology Service document receipt of referral and any followup care in EHR Offered at every clinic visit but no more than once a week. Patient may decline to participate. …Current Distress Screening & Management at UFHCC Routine Psychological Evaluation – Hematopoietic Stem Cell Transplant patients – Prophylactic Mastectomy patients Referral-Based Psychological Evaluation (2003 – Present) – Evaluation and treatment of mental and behavioral health issues in the context of cancer survivorship Range of Mental Health Issues Treated at UFHCC Delirium Personality D/O Adjustment D/O Health Behaviors Nonadherence Relational Issues Anxiety D/O Psychosis Depressive D/O Substance D/O Posttraumatic Suicidality Stress D/O Integration of Distress Screening Practice and Research “Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening.” “Screening is resource intensive, and questions can be raised as to what alternative purposes the resources consumed by screening could be put…apply the resources that would otherwise go to screening instead to facilitating completion of referrals for the minority of patients who want services, particularly those who are having low income or otherwise disadvanged…screening for distress should not be implemented without demonstration that it actually improves patient outcomes over routine care and that benefits exceed costs at patient and system levels.” Thank you!