Background:
Up to 60% of patients with cancer experience long-term distress, with 20%-35% experiencing anxiety or depression. Many distressed in-patients are not identified or referred for psychosocial support until in crisis. The aim of this project was to trial a new system of screening in-patients to better identify distressed patients, to examine the causes of their distress and to improve psychosocial referral.
Methods:
A total of 115 in-patients (78 men, 38 women) on the oncology ward at the Alfred Hospital in Melbourne were screened using two self-report tools: 1) Brief Symptom Inventory-18 (BSI) assessing somatic distress, depression and anxiety and 2) distress thermometer (DT) assessing global distress (0-10) and practical, emotional, spiritual and physical problems.
Results:
About 52% of patients reported significant distress (50% on the DT, 20% on the BSI). Of these, 25% had not been followed up by psychosocial services. Newly diagnosed patients reported greater distress than patients receiving palliative or curative treatment. A psychiatric history was also associated with significantly greater distress. Problems with fatigue (66%), sleep (50%), eating (54%), fears (41%), loss of interest (34%), memory/concentration (31%) and finances (20%) were common. Family and friends, keeping busy, staying positive, staff expertise and care, setting goals, and maintaining a sense of normality were helpful coping strategies.
Conclusions:
There is a high prevalence of unidentified distress in patients on the oncology ward, who would not normally be referred for psychosocial support. Proactive screening of patients can help detect distress and avoid crises by referral to psychosocial support services.
