0178 --Implementation of aaScreening Programme for Cancer
  0178 Implementation of Screening Programme for Cancer
Related ...
Concepts of Implementation
  Staff Recognition (unassisted)     Baseline


  Tool Validity (vs gold standard)

           ...
Audit / Research Protocol

   Phase I – DT across LNR network (incl training)


   Phase II – Enhancements to DT


   Phas...
Phase I
Phase II
Phase II
DepT
 DT
                                                               23%
37%
                        4%                ...
More than just “distress”
Of 401 chemotherapy attendees

  59% have an emotional complication (3v4)

  37% (62% of 59%) it...
Local Study: Recognition by CNS in oncology


      Approached - 800 patients

      Willing    -   700

      Assessed   ...
Phase II Results – detection baseline
100.0
                                                                                  5.9
                              ...
Phase II Results Post ET (DT)

   1. Does tool influence detections?


   2. Does tool influence quality of care?
Graphical – Screening principles

 #
 of                             Cut-Off
 Individuals
                                ...
Pre Screen – Ability of Clinicians to Detect
                             Before

Sensitivity Distress         49.7%

Sens...
Ability of Clinicians to Detect Healthy
                             Before

Specificity Distress         79.3%

Specifici...
Pre-Post Screen – Change?
                    Before   After

Change distress =>+5%

Change depression =>+3%

Change anxie...
Qualitative benefits

DEPRESSION

 38% of occasions reported useful in improving communication.

 28.6% useful for informi...
FURTHER READING:

Screening for Depression in Clinical Practice An
   Evidence-Based guide

   ISBN 0195380193
   Paperbac...
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IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression

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Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression

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IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression

  1. 1. 0178 --Implementation of aaScreening Programme for Cancer 0178 Implementation of Screening Programme for Cancer Related Distress: Part II --Does Screening Aid Clinicians’ Related Distress: Part II Does Screening Aid Clinicians’ Communication, Judgement or Accuracy of Anxiety and Depression? Communication, Judgement or Accuracy of Anxiety and Depression? 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 Detection Before tool Clinician management Patient wellbeing 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. 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%
  8. 8. 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%
  9. 9. Local Study: Recognition by CNS in oncology Approached - 800 patients Willing - 700 Assessed - 500 Returned - 402
  10. 10. Phase II Results – detection baseline
  11. 11. 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 40.0 24.4 82.4 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
  12. 12. Phase II Results Post ET (DT) 1. Does tool influence detections? 2. Does tool influence quality of care?
  13. 13. Graphical – Screening principles # of Cut-Off Individuals Low High Non-Depressed <<<< low Specificity Severity of Depression High Sensitivity >>>> Depressed # of Individuals
  14. 14. Pre Screen – Ability of Clinicians to Detect Before Sensitivity Distress 49.7% Sensitivity Depression 55.4% Sensitivity Anxiety 41.7% Sensitivity Anxiety or Dep 41.7%
  15. 15. Ability of Clinicians to Detect Healthy Before Specificity Distress 79.3% Specificity Depression 87.5% Specificity Anxiety 81.9% Specificity Anxiety or Dep 80.5%
  16. 16. Pre-Post Screen – Change? Before After Change distress =>+5% Change depression =>+3% Change anxiety =>+4%
  17. 17. Qualitative benefits DEPRESSION 38% of occasions reported useful in improving communication. 28.6% useful for informing clinical judgement
  18. 18. FURTHER READING: Screening for Depression in Clinical Practice An Evidence-Based guide ISBN 0195380193 Paperback, 416 pages Nov 2009 Price: £39.99

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