IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Distress: Part III - Does Screening Aid Clinicians' Quality of Care
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IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Distress: Part III - Does Screening Aid Clinicians' Quality of Care

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IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Distress: Part III - Does Screening Aid Clinicians' Quality of Care Presentation Transcript

  • 1. 680 --Implementation of a Screening Programme for 680 Implementation of a Screening Programme for Cancer Related Distress: Part III – Cancer Related Distress: Part III – Does Screening Aid Clinicians’ Quality of Care? Does Screening Aid Clinicians’ Quality of Care? Alex Mitchell www.psycho-oncology.info Paul Symonds Lorraine Grainger Elena Baker-Glenn Department of Cancer & Molecular Medicine, Leicester Royal Infirmary IPOS2010
  • 2. Concepts of Implementation Staff Recognition (unassisted) Baseline Tool Validity (vs gold standard) Pilot tool Tool acceptability Detection Before tool Clinician management Patient wellbeing Detection Clinician management Patient wellbeing After tool
  • 3. Defining Quality of Care
  • 4. Defining Quality of Care Clinician takes appropriate action Unmet needs are met Meetable unmet needs are met, by clinician without delay
  • 5. 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
  • 6. Phase II
  • 7. Phase II Results Post ET (DT) 1. Does tool influence detections? 2. Does screening influence quality of care?
  • 8. Interim 269 Nurse-patient interactions Helped 65 (24%) Not Helped 204 (76%) Referred 23 (8.6%) Declined Helped 20 (7.4%) No Unmet Needs 34 (12.6%) Unmet Needs 150 (55.8%) p179
  • 9. Overall clinician care Of 402 nurse-patient interactions: no action was taken in 62% (of which 10% patients declined) patient were helped in 38% of consultations. Of those helped, a referral was made in 25.9% of cases (10% overall)
  • 10. Clinician Care by Patient distress Of 183 who screened positive for distress 108 (59%) were helped Of 219 without distress, 44 (20%) were offered help (Chi² = 14 P < 0.001).
  • 11. Clinician Care by Patient Depression Of 70 who screened positive for depression 28 (38.6%) were helped Of 219 without depression, 48 (22%) were offered help (Chi² = 14 P < 0.001).
  • 12. 2x2 Clinician Help Table : by Diagnosis Diagnosis Yes Diagnosis No Distress 59% helped 20% helped Anxiety 33% helped 17.5% helped Depression 39% helped 22% helped Anger 30% helped 24% helped Any 46% helped 20% helped
  • 13. Effect of Screening…more than distress Screening influences - Clarification of patient distress Clarification of clinician opinion Clarification of unmet needs Clarification of desire for help
  • 14. 2x2 Clinician Help Table : ACTUAL HELP Clinician thinks: Clinician thinks no Unmet Needs Unmet Needs Patient Says: => Intervention => Low grade Help Wanted Patient Distressed => Intervention =>?? Patient Not => Monitor? => discharge? distressed or Help Not Wanted
  • 15. Clinician help combined In those with patient reported distress + clinician evaluated distress 22/65 (33.8%) were offered help and 16% offered referral. In those with neither patient reported nor clinician evaluated distress 10/90 (11.1%) were offered help and 2% offered referral. In those with patient reported distress + clinician evaluated distress + also wanted help 56% were helped
  • 16. 2x2 Clinician Help Table : ACTUAL HELP Clinician thinks: Clinician thinks Unmet Needs no Unmet Needs Patient Says: Helped 21/35 Helped 11/23 Help Wanted Patient Helped 65/102 Helped 31/62 Distressed Patient Not Helped 8/35 Helped 20/117 distressed or Help Not Wanted
  • 17. Phase III Radiotherapy screen implementation – RCT of screen + intervention
  • 18. 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