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What to do with screening for distress scores? Integrating descriptive data into clinical practice

Published online by Cambridge University Press:  02 August 2013

Marie-Claude Blais ,
Alexandre St-Hilaire ,
Lise Fillion ,
Marie De Serres  and
Annie Tremblay
Marie-Claude Blais*
Affiliation:
Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
Alexandre St-Hilaire
Affiliation:
School of Psychology, Laval University, QC, Canada
Lise Fillion
Affiliation:
Nursing Faculty, Laval University, QC, Canada
Marie De Serres
Affiliation:
Centre Hospitalier Universitaire de Québec (CHUQ), Hôtel-Dieu de Québec, QC, Canada
Annie Tremblay
Affiliation:
Centre Hospitalier Universitaire de Québec (CHUQ), Hôtel-Dieu de Québec, QC, Canada
*
Address correspondence and reprint requests to: Marie-Claude Blais, Pavillon Michel Sarrazin, Département de Psychologie, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, Québec, G9A 5H7, Canada. E-mail: [email protected]
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Abstract

Objective:

Implementation of routine Screening for Distress constitutes a major change in cancer care, with the aim of achieving person-centered care.

Method:

Using a cross-sectional descriptive design within a University Tertiary Care Hospital setting, 911 patients from all cancer sites were screened at the time of their first meeting with a nurse navigator who administered a paper questionnaire that included: the Distress Thermometer (DT), the Canadian Problem Checklist (CPC), and the Edmonton Symptom Assessment System (ESAS).

Results:

Results showed a mean score of 3.9 on the DT. Fears/worries, coping with the disease, and sleep were the most common problems reported on the CPC. Tiredness was the most prevalent symptom on the ESAS. A final regression model that included anxiety, the total number of problems on the CPC, well-being, and tiredness accounted for almost 50% of the variance of distress. A cutoff score of 5 on the DT together with a cutoff of 5 on the ESAS items represents the best combination of specificity and sensitivity to orient patients on the basis of their reported distress.

Significance of results:

These descriptive data will provide valuable feedback to answer practical questions for the purpose of effectively implementing and managing routine screening in cancer care.

Keywords

CancerScreening for DistressChange of practiceDistressPatients' needsNurse navigator
Type
Original Articles
Information
Palliative & Supportive Care , Volume 12 , Issue 1 , February 2014 , pp. 25 - 38
Copyright
Copyright © Cambridge University Press 2013 

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References

REFERENCES

Absolom, K., Holch, P., Pini, S., et al. (2011). The detection and management of emotional distress in cancer patients: The views of health-care professionals. Psychooncology, 20, 601–608.Google Scholar
Accreditation Canada (2009). Cancer Care and Oncology Services Standards. http://www.accreditation.ca/accreditation-programs/qmentum/standards/cancer-care/Google Scholar
Annunziata, M.A., Muzzatti, B. & Bidoli, E. (2011). Psychological distress and needs of cancer patients: A prospective comparison between the diagnostic and the therapeutic phase. Supportive Care in Cancer, 19, 291–295.Google Scholar
Ashbury, F.D., Findlay, H., Reynolds, B., et al. (1998). A Canadian survey of cancer patients' experiences: Are their needs being met? Journal of Pain and Symptom Management, 16, 298–306.Google Scholar
Bruera, E., Kuehn, N., Miller, M.J., et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7, 6–9.Google Scholar
Bulli, F., Miccinesi, G., Maruelli, A., et al. (2009). The measure of psychological distress in cancer patients: The use of Distress Thermometer in the Oncological Rehabilitation Center of Florence. Supportive Care in Cancer, 17, 771–779.Google Scholar
Bultz, B.D. & Carlson, L.E. (2006). Emotional distress: the sixth vital sign—future directions in cancer care. Psycho-oncology, 15, 93–95.Google Scholar
Bultz, B.D., Groff, S.L., Fitch, M., et al. (2011). Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice. Psychooncology, 20, 463–469.Google Scholar
Bultz, B.D. & Holland, J.C. (2006). Emotional distress in patients with cancer: The sixth vital sign. Community Oncology, 3, 311–314.Google Scholar
Canadian Partnership Against Cancer (2008). Annual Report 2007–2008. http://www.partnershipagainstcancer.ca/wp-content/uploads/3.1.4-CPAC_ENG_AR07_08_web.pdfGoogle Scholar
Canadian Partnership Against Cancer, Cancer Journey Action Group (2009). Guide to Implementing Screening for Distress, the 6th Vital Sign, Part A: Background, Recommendations, and Implementation. http://www.partnershipagainstcancer.ca/wp-content/uploads/2.4.0.1.4.5-Guide_CJAG.pdfGoogle Scholar
Cancer Care Ontario (2011) Symptom Management Guides. https://www.cancercare.on.ca/toolbox/symptools/Google Scholar
Carlson, L.E., Angen, M., Cullum, J., et al. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90, 2297–2304.Google Scholar
Carlson, L.E. & Bultz, B.D. (2004). Efficacy and medical cost offset of psychosocial interventions in cancer care: making the case for economic analyses. Psycho-oncology, 13, 837–849.Google Scholar
Carlson, L.E., Groff, S.L., Maciejewski, O., et al. (2010). Screening for distress in lung and breast cancer outpatients: A randomized controlled trial. Journal of Clinical Oncology, 28, 4884–4891.Google Scholar
Chang, V.T., Hwang, S.S. & Feuerman, M. (2000). Validation of the Edmonton Symptom Assessment Scale. Cancer, 88, 2164–2171.Google Scholar
Cohen, J. (1988). The t test for means. In Statistical Power Analysis for the Behavioral Sciences, 2nd ed.Cohen, J. (ed.), Hillsdale, NJ: Erlbaum Associates, pp. 25–27.Google Scholar
Direction de la lutte contre le cancer, Ministère de la santé et des services sociaux du Québec. (2011). Rapport du Comité d'oncologie psychosociale: Vers des soins centrés sur la personne. [Report of the Committee of psychosocial oncology: towards a person-centered care.] http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2011/11-902-05F.pdfGoogle Scholar
Dolbeault, S., Boistard, B., Meuric, J., et al. (2011). Screening for distress and supportive care needs during the initial phase of the care process: A qualitative description of a clinical pilot experiment in a French cancer center. Psycho-oncology, 20, 585–593.Google Scholar
Dolbeault, S., Bredart, A., Mignot, V., et al. (2008). Screening for psychological distress in two French cancer centers: Feasibility and performance of the adapted distress thermometer. Palliative & Supportive Care, 6, 107–117.Google Scholar
Fillion, L., Cook, S., Blais, M. C., et al. (2011). Implementation of screening for distress with professional cancer navigators. Oncologie (Paris), 13, 277–289.Google Scholar
Fillion, L., Cook, S., Veillette, A.M., et al. (2012). Professional navigation framework: elaboration and validation in a Canadian context. Oncology Nursing Forum, 39, E58–69.Google Scholar
Fitch, M. I. (2008). Providing supportive care. In Supportive Care Framework: A Foundation for Person-Centred Care. Pembroke: Pappin Communications, pp. 23–24.Google Scholar
Fitch, M.I., Howell, D., McLeod, D., et al. (2012). Screening for distress: responding is a critical function for oncology nurses. Canadian Oncology Nursing Journal, 22, 12–30.CrossRefGoogle ScholarPubMed
Frick, E., Tyroller, M. & Panzer, M. (2007). Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre. European Journal of Cancer Care, 16, 130–136.Google Scholar
Gil, F., Grassi, L., Travado, L., et al. (2005). Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Support Care Cancer, 13, 600–606.Google Scholar
Grassi, L., Nanni, M.G. & Caruso, R. (2010). Emotional distress in cancer: screening policy, clinical limitations and educational needs. Journal of Medicine and the Person, 8, 51–59.CrossRefGoogle Scholar
Graves, K.D., Arnold, S.M., Love, C.L., et al. , (2007). Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress. Lung Cancer, 55, 215–224.Google Scholar
Holland, J.C. & Bultz, B.D. (2007). The NCCN guideline for distress management: A case for making distress the sixth vital sign. Journal of the National Comprehensive Cancer Network, 5, 3–7.Google Scholar
Howell, D. (2010). Psychological distress as a nurse sensitive outcome. In Nurse Outcomes; State of the Science Doran, D. (ed.),. Mississauga, Ontario: Jones and Bartlett Publishers, pp. 285–358.Google Scholar
Jacobsen, P.B., Donovan, K.A., Trask, P.C., et al. (2005). Screening for psychologic distress in ambulatory cancer patients. Cancer, 103, 1494–1502.Google Scholar
Kirkova, J., Davis, M.P., Walsh, D., et al. (2006). Cancer symptom assessment instruments: A systematic review. Journal of Clinical Oncology, 24, 1459–1473.Google Scholar
Linden, W., Yi, D., Barroetavena, M.C., et al. (2005). Development and validation of a psychosocial screening instrument for cancer. Health and Quality of Life Outcomes, 3, 54.Google Scholar
National Comprehensive Cancer Network (2010). Clinical Practice Guidelines in Oncology TM, Distress Management V.1. http://www.nccn.org/professionals/physician_gls/PDF/distress.pdfGoogle Scholar
Neilson, K.A., Pollard, A.C., Boonzaier, A.M., et al. (2010). Psychological distress (depression and anxiety) in people with head and neck cancers. The Medical Journal of Australia, 193(Suppl), S48–51.Google Scholar
Nekolaichuk, C., Watanabe, S. & Beaumont, C. (2008). The Edmonton Symptom Assessment System: A 15-year retrospective review of validation studies (1991–2006). Palliative Medicine, 22, 111–122.Google Scholar
Ozalp, E., Cankurtaran, E.S., Soygur, H., et al. (2007). Screening for psychological distress in Turkish cancer patients. Psycho-oncology, 16, 304–311.Google Scholar
Ransom, S., Jacobsen, P.B. & Booth-Jones, M. (2006). Validation of the Distress Thermometer with bone marrow transplant patients. Psycho-oncology, 15, 604–612.Google Scholar
Rebalance Focus Action Group (2005). A position paper: screening key indicators in cancer patients: pain as a fifth vital sign and emotional distress as a sixth vital sign. Canadian Strategy for Cancer Control Bulletin, 7(Suppl.), 4.Google Scholar
Richardson, L.A. & Jones, G.W. (2009). A review of the reliability and validity of the Edmonton Symptom Assessment System. Current Oncology, 16, 55.Google Scholar
Roth, A.J., Kornblith, A.B., Batel-Copel, L., et al. (1998). Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer, 82, 1904–1908.Google Scholar
Senf, B., Brandt, H., Dignass, A., et al. (2010). Psychosocial distress in acute cancer patients assessed with an expert rating scale. Supportive Care in Cancer, 18, 957–965.Google Scholar
Swets, J.A., Dawes, R.M., & Monahan, J. (2000). Psychological science can improve diagnostic decisions. Psychological Science in the Public Interest, 1, 1–26.Google Scholar
Tabachnick, B.G., & Fidell, L.S. (2006). Multiple Regressions. In Using Multivariate Statistics, 5th ed.Tabachnick, B. G. & Fidell, L. S. (eds.), Needham Heights, MA: Allyn and Bacon Inc., pp. 152.Google Scholar
van Scheppingen, C., Schroevers, M.J., Smink, A., et al. (2011). Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psycho-oncology, 20, 655–663.Google Scholar
Vignaroli, E., Pace, E.A., Willey, J., et al. (2006).The Edmonton Symptom Assessment System as a screening tool for depression and anxiety. Journal of Palliative Medicine, 9, 296–303.Google Scholar
Vitek, L., Rosenzweig, M.Q. & Stollings, S. (2007). Distress in patients with cancer: Definition, assessment, and suggested interventions. Clinical Journal of Oncology Nursing, 11, 413–418.CrossRefGoogle ScholarPubMed
Watanabe, S.M., Nekolaichuk, C.L. & Beaumont, C. (2011). The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: development and refinement. Psycho-oncology.Google ScholarPubMed
Watson, M., & Bultz, B. (2010). Distress, the 6th vital sign in cancer care. Psycho-oncology, 4, 159–163.Google Scholar
Zabora, J., BrintzenhofeSzoc, K., Curbow, B., et al. (2001). The prevalence of psychological distress by cancer site. Psycho-oncology, 10, 19–28.Google Scholar