T177 --Implementation of aaScreening Programme for Cancer
 T177 Implementation of Screening Programme for Cancer
       Re...
Concepts of Implementation
  Staff Recognition (unassisted)     Baseline




  Tool Validity (vs gold standard)   Pilot to...
Audit / Research Protocol

   Phase I – DT across LNR network (incl training)


   Phase II – Enhancements to DT


   Phas...
Phase I
Phase II
Phase II
1.00


0.90


0.80
                                                                                 Ten
0.70              ...
DepT
 DT
                                                               23%
37%
                        4%                ...
More than just “distress”
Of 401 chemotherapy attendees

  59% have an emotional complication (3v4)

  37% (62% of 59%) it...
Leicester: DT/ET Implementation                                      T177 t680




                          800 Patients ...
Phase II Results – detection baseline
100.0
                                                                                  5.9
                              ...
Detection sensitivity = 50.6%
1.00
                                   Detection specificity = 79.4%
           Post-test P...
Phase II Results Post ET (DT)

   1. Does tool influence detections?


   2. Does tool influence quality of care?
Pre-Post Screen - Distress
                    Before   After

Sensitivity of      49.7%

Specificity of      79.3%

PPV w...
Pre-Post Screen - Distress
                               Before                  After

Sensitivity of                 49...
Screening a failure?
Clover, Carter et al (unpublished)



                            35

                            30
% patients over thres...
a. Communication
DISTRESS

 43% of CNS reported the tool helped them talk with the patient
 about psychosocial issues esp ...
Credits & Acknowledgments

  Elena Baker-Glenn      University of Nottingham
  Paul Symonds           Leicester Royal Infi...
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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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IPOS10 T177- Implementation of a Screening Programme for Cancer Related Distress: Part I - Does Screening Influence Detection of Distress

  1. 1. T177 --Implementation of aaScreening Programme for Cancer T177 Implementation of Screening Programme for Cancer Related Distress: Related Distress: Part II--Does Screening Influence Detection of Distress? Part Does Screening Influence Detection of Distress? 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
  2. 2. Concepts of Implementation Staff Recognition (unassisted) Baseline Tool Validity (vs gold standard) Pilot tool Tool acceptability Before tool Detection Clinician management Patient wellbeing After tool
  3. 3. Audit / Research Protocol Phase I – DT across LNR network (incl training) Phase II – Enhancements to DT Phase III - Screening plus Intervention
  4. 4. Phase I
  5. 5. Phase II
  6. 6. Phase II
  7. 7. 1.00 0.90 0.80 Ten 0.70 Nine Eight 0.60 Seven Six 0.50 Five Four 0.40 Three Two 0.30 One 0.20 Zero Comment: Slide illustrates scores on ET 0.10 tool 0.00 Distress Anxiety Depression Anger Thermometer Thermometer Thermometer Thermometer
  8. 8. DepT DT 23% 37% 4% 3% 3% DT DepT 7% 1% Non-Nil 8% 0% Nil 9% 59% 41% 4% 1% AnxT 2% AngT 15% 2% AnxT AngT 47% 18%
  9. 9. More than just “distress” Of 401 chemotherapy attendees 59% have an emotional complication (3v4) 37% (62% of 59%) it included distress 23% it excluded distress Validity of DT vs depression (DSMIV) SE 80% SP 60% PPV 32% NPV 93% Of 64 DSM-MDD 50 +ve on DT
  10. 10. 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
  11. 11. Phase II Results – detection baseline
  12. 12. 100.0 5.9 11.1 14.3 90.0 Comment: Slide illustrates diagnostic 21.4 accuracy according to score on DT 11.8 25.9 80.0 38.7 38.1 43.5 22.2 14.3 46.7 70.0 59.6 21.4 72.4 60.0 Judgement = Non-distressed 33.3 Judgement = Unclear 19.4 19.0 Judgement = Distressed 50.0 26.1 24.4 82.4 40.0 71.4 66.7 30.0 25.0 57.1 41.9 42.9 40.7 20.0 15.8 30.4 28.9 10.0 15.4 11.8 0.0 Zero One Two Three Four Five Six Seven Eight Nine Ten
  13. 13. Detection sensitivity = 50.6% 1.00 Detection specificity = 79.4% Post-test Probability Overall accuracy = 65.4%. 0.90 0.80 0.70 0.60 CHEMO+ 0.50 CHEMO- 0.40 Baseline Probability 0.30 COMMU+ COMMU- 0.20 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Comment: Slide illustrates performance of chemotherapy vs community nurses in oncology
  14. 14. Phase II Results Post ET (DT) 1. Does tool influence detections? 2. Does tool influence quality of care?
  15. 15. Pre-Post Screen - Distress Before After Sensitivity of 49.7% Specificity of 79.3% PPV was 67.3% NPV was 64.1%
  16. 16. Pre-Post Screen - Distress Before After Sensitivity of 49.7% 55.8% =>+5% Specificity of 79.3% 79.8% =>+1% PPV was 67.3% 70.9% =>+4% NPV was 64.1% 67.2% =>+3% There was a non-significant trend for improve detection sensitivity (Chi² = 1.12 P = 0.29).
  17. 17. Screening a failure?
  18. 18. Clover, Carter et al (unpublished) 35 30 % patients over threshold Distress 25 Pain 20 15 10 5 0 1 2 3 4 5 6 7 8 Quarter of screening First occasion of screening (n=4543)
  19. 19. a. 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
  20. 20. 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

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