680 --Implementation of a Screening Programme for
 680 Implementation of a Screening Programme for
      Cancer Related Di...
Concepts of Implementation
 Staff Recognition (unassisted)     Baseline


 Tool Validity (vs gold standard)

             ...
Defining Quality of Care
Defining Quality of Care



 Clinician takes appropriate action

 Unmet needs are met

 Meetable unmet needs are met, by c...
Leicester: DT/ET Implementation                                      T177 t680




                          800 Patients ...
Phase II
Phase II Results Post ET (DT)

   1. Does tool influence detections?


   2. Does screening influence quality of care?
Interim
                          269 Nurse-patient
                             interactions



      Helped 65 (24%)    ...
Overall clinician care
Of 402 nurse-patient interactions:

  no action was taken in 62% (of which 10% patients
  declined)...
Clinician Care by Patient distress

 Of 183 who screened positive for distress 108 (59%)
 were helped


 Of 219 without di...
Clinician Care by Patient Depression

 Of 70 who screened positive for depression 28 (38.6%)
 were helped


 Of 219 withou...
2x2 Clinician Help Table : by Diagnosis
              Diagnosis Yes   Diagnosis No


Distress      59% helped      20% hel...
Effect of Screening…more than distress

Screening influences -

     Clarification of patient distress

     Clarification...
2x2 Clinician Help Table : ACTUAL HELP
                     Clinician thinks:   Clinician thinks no
                     U...
Clinician help combined
In those with patient reported distress + clinician
  evaluated distress 22/65 (33.8%) were offere...
2x2 Clinician Help Table : ACTUAL HELP
                    Clinician thinks:   Clinician thinks
                    Unmet ...
Phase III


            Radiotherapy screen implementation

                  – RCT of screen + intervention
Credits & Acknowledgments

  Elena Baker-Glenn      University of Nottingham
  Paul Symonds           Leicester Royal Infi...
IPOS10 T680 - Implementation of a Screening Programme for Cancer Related Distress: Part III - Does Screening Aid Clinician...
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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

  1. 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. 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. Defining Quality of Care
  4. 4. Defining Quality of Care Clinician takes appropriate action Unmet needs are met Meetable unmet needs are met, by clinician without delay
  5. 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. 6. Phase II
  7. 7. Phase II Results Post ET (DT) 1. Does tool influence detections? 2. Does screening influence quality of care?
  8. 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. 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. 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. 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. 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. 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. 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. 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. 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. 17. Phase III Radiotherapy screen implementation – RCT of screen + intervention
  18. 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

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