Screening for cancer-related distress: When is implementation successful and when is it unsuccessful?

Figures & data

Table I. Methodology of screening studies.

Type screening study	Purpose of study	Description of study
Diagnostic validity study	Establish diagnostic accuracy of a tool against a gold standard instrument	A screening tool is tested against a criterion (gold standard) in a real world sample generating the sensitivity and specificity of the tool, as well as positive and negative predictive value which depend on the cut-off chosen and the prevalence of distress.
Non-randomized sequential cohort Implementation study	Establish the added value of screening on patient outcomes and quality of care	The screening tool is evaluated clinically in one group of clinicians with access to screening (or results of screening) compared to a second group (typically a historical group or second centre) who do not access to screening (or results of screening)
Randomized controlled Implementation study (screen vs no-screen)	Establish the added value of screening on patient outcomes and quality of care, controlling for baseline variability	Two equal groups of clinicians (or in the case of ‘cluster randomization’ centres) are randomized to have either access to a screening method vs no access to screening.
Randomized controlled Implementation study (screen + feedback vs screen no feedback)	Establish the added value of screening feedback on patient outcomes and quality of care, controlling for baseline variability	Two equal groups of clinicians (or in the case of ‘cluster randomization’ centres) are randomized to have either access to results of screening vs screening but no access to the results of screening (screen no feedback).
Observational Implementation screening study	Establish effect of screening on clinical practice (uncontrolled)	A screening tool is introduced in clinical practice and the effect on quality of care (process measures) or patient reported outcomes monitored. This can be conducted using current or historical screening data

Table II. Brief summary of successful and unsuccessful distress screening implementation studies.

Author/Country	Screening target	Screening beneficial?	PROs improved?	Referrals improved?	Communication improved?	Acceptability of screening?
Randomized Unsuccessful
Maunsell et al. (1996) [35] Canada	Distress Depression	No	No	NR	No	NR
Rosenbloom et al. (2007) [36] USA	Mood Quality of life	No	No	NR	NR	NR
Mills et al. (2009) [42] UK	Quality of life	No (deleterious)	No	NR	Yes but not significantly	High
Braeken et al. (2011) [37] Germany	Distress	No	No	Yes (but not significantly)	NR	Mixed
Hollingworth et al. (2012) [38] UK	Distress Quality of life	No	No	NR	NR	High
Randomized successful
Sarna (1998) [31] USA	Distress	Yes	Yes	NR	Yes	NR
McLachlan et al. (2001) [32] Australia	Distress Depression Unmet needs	Partial (in depressed patients)	Yes (in depressed only)	NR	Yes (in depressed only)	NR
Detmar et al. (2002) [39] Netherlands	Quality of life	Partial	No	NR	Yes (but only for social functioning, fatigue and dyspnea)	NR
Velikova et al. (2004) [33] UK	Distress Quality of life	Yes	Yes	NR	Yes but not significantly	Mixed
Macvean et al. (2007) [43] Australia	Quality of life Unmet needs Depression	Yes	Yes (depression)	NR	NR	Good
Girgis et al. (2009) [44] Australia	Unmet needs Depression Quality of life	Partial (in communication and action)	No	Yes and significant (but full data not presented)	Yes and significant (but full data not presented)	High
Carlson et al. (2010) [28] Canada	Distress	Yes (in breast and lung cancer)	No	Yes significantly	NR	High
Carlson et al. (2012) [45] Canada	Distress	No	Yes	Yes (access to services) significantly	NR	High
Klinkhammer-Schalke et al. (2012) [34] Germany	Quality of life	Yes	Yes	NR	NR	Not reported
Non-randomized unsuccessful
Boyes et al. (2006) [46] Australia	Depression/anxiety Unmet needs	No	No	NR	NR	Yes
Mitchell et al. (2012) [47] UK	Distress Depression/anxiety/anger	Not significantly	No	NR	NR	Partial
Non-randomized successful
Taenzer et al. (2000) [48] Canada	Quality of life	Partial (in communication and action)	Yes	NR	Yes but not significantly	NR
Pruyn et al. (2004) [49] Netherlands	Distress	Yes	NR	Yes significantly	Yes but not significantly	Duration of consultations decreased & screening acceptable to 77% of patients
Bramsen et al. (2008) [50] Netherlands	Distress Quality of life	Yes	Partial	Yes significantly	NR	NR
Hilarius et al. (2008) [51] Netherlands	Quality of life	Partial (in recognition and action)	No	Yes (but not significantly)	Yes significantly overall	NR
Thewes et al. (2009) [52] Australia	Distress Unmet needs	Partial (in referral delay)	No	Yes but not significantly	NR	Yes
Shimizu et al. (2010) [53] Japan	Distress	Partial (in referral)	No/Unknown	Yes significantly	NR	NR
Ito et al. (2011) [54] Japan	Distress	Partial (in referral delay)	No	Yes, significantly	NR	NR
Grassi et al. (2011) [55] Italy	Distress	Partial (in referral)	No	Yes, significantly	No	NR

NR, not recorded.

Maunsell E, Brisson J, Deschenes L, Frasure-Smith N. Randomized trial of a psychologic distress screening program after breast cancer: Effects on quality of life. J Clin Oncol 1996;14:2747–55.

 PubMed Web of Science ®Google Scholar

Rosenbloom SK, Victorson DE, Hahn EA, Peterman AH, Cella D. Assessment is not enough: A randomized controlled trial of the effects of HRQL assessment on quality of life and satisfaction in oncology clinical practice. Psychooncology 2007;16:1069–79.

 PubMed Web of Science ®Google Scholar

Mills ME, Murray LJ, Johnston BT, Cardwell C, Donnelly M. Does a patient-held quality-of-life diary benefit patients with inoperable lung cancer? J Clin Oncol 2009;27:70–7.

 PubMed Web of Science ®Google Scholar

Braeken AP, Kempen GI, Eekers D, van Gils FC, Houben RM, Lechner L. The usefulness and feasibility of a screening instrument to identify psychosocial problems in patients receiving curative radiotherapy: A process evaluation. BMC Cancer 2011;11:479.

 PubMed Web of Science ®Google Scholar

Hollingworth W, Harris S, Metcalfe C, Mancero S, Biddle L, Campbell R, . Evaluating the effect of using a distress thermometer and problem list to monitor psychosocial concerns among patients receiving treatment for cancer: Preliminary results of a randomised controlled trial. Psychooncology 2012;21:s2.

 Google Scholar

Sarna L. Effectiveness of structured nursing assessment of symptom distress in advanced lung cancer. Oncol Nurs Forum 1998;25:1041–8.

 PubMedGoogle Scholar

McLachlan SA, Allenby A, Matthews J, Wirth A, Kissane D, Bishop M, . Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. J Clin Oncol 2001;19:4117–25.

 PubMed Web of Science ®Google Scholar

Detmar SB, Muller MJ, Schornagel JH, Wever LD, Aaronson NK. Health-related quality-of-life assessments and patient-physician communication: A randomized controlled trial. JAMA 2002;288:3027–34.

 PubMed Web of Science ®Google Scholar

Velikova G, Booth L, Smith AB, Brown PM, Lynch P, Brown JM, . Measuring quality of life in routine oncology practice improves communication and patient well-being: A randomized controlled trial. J Clin Oncol 2004;22:714–24.

 PubMed Web of Science ®Google Scholar

Macvean ML, White VM, Pratt S, Grogan S, Sanson-Fisher R. Reducing the unmet needs of patients with colorectal cancer: A feasibility study of The Pathfinder Volunteer Program. Support Care Cancer 2007;15:293–9.

 PubMed Web of Science ®Google Scholar

Girgis A Breen S, Stacey F, Lecathelinais C. Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients with nonlocalized breast and colorectal cancers. J Clin Oncol 2009;27:6180–90.

 PubMed Web of Science ®Google Scholar

Carlson LE, Groff SL, Maciejewski O, Bultz BD. Screening for distress in lung and breast cancer outpatients: A randomized controlled trial. J Clin Oncol 2010;28:4884–91.

 PubMed Web of Science ®Google Scholar

Carlson LE, Waller A, Groff SL, Zhong L, Bultz BD. Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: Randomised controlled trial of computerised vs personalised triage. Br J Cancer 2012;107:617–25.

 PubMed Web of Science ®Google Scholar

Klinkhammer-Schalke M, Koller M, Steinger B, Ehret C, Ernst B, Wyatt JC, , Regensburg QoL Study Group.Direct improvement of quality of life using a tailored quality of life diagnosis and therapy pathway: Randomised trial in 200 women with breast cancer.Br J Cancer 2012;106:826–38.

 PubMed Web of Science ®Google Scholar

Boyes A, Newell S, Girgis A, McElduff P, Sanson-Fisher R. Does routine assessment and real-time feedback improve cancer patients’ psychosocial well-being? Eur J Cancer Care (Engl) 2006;15:163–71.

 PubMed Web of Science ®Google Scholar

Mitchell AJ, Lord K, Slattery J, Grainger L, Symonds P. How feasible is implementation of distress screening by cancer clinicians in routine clinical care? Cancer 2012;118:6260–9.

 PubMed Web of Science ®Google Scholar

Taenzer P, Bultz BD, Carlson LE, Speca M, DeGagne T, Olson K, . Impact of computerized quality of life screening on physician behaviour and patient satisfaction in lung cancer outpatients. Psychooncology 2000;9:203–13.

 PubMed Web of Science ®Google Scholar

Pruyn JF, Heule-Dieleman HA, Knegt PP, Mosterd FR, van Hest MA, Sinnige HA, . On the enhancement of efficiency in care for cancer patients in outpatient clinics: An instrument to accelerate psychosocial screening and referral. Patient Educ Couns 2004;53:135–40.

 PubMed Web of Science ®Google Scholar

Bramsen I, van der Linden MH, Eskens FJ, Bijvank EM, van Groeningen CJ, Kaufman HJ, . Evaluation of a face-to-face psychosocial screening intervention for cancer patients: Acceptance and effects on quality of life. Patient Educ Couns 2008;70:61–8.

 PubMed Web of Science ®Google Scholar

Hilarius DL, Kloeg PH, Gundy CM, Aaronson NK. Use of health-related quality-of-life assessments in daily clinical oncology nursing practice: A community hospital-based intervention study. Cancer 2008;113:628–37.

 PubMed Web of Science ®Google Scholar

Thewes B, Butow P, Stuart-Harris R, Greater Southern Area Health Service Screening Collaborative Group. Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study. Aust J Rural Health 2009;17:298–304.

 PubMed Web of Science ®Google Scholar

Shimizu K, Ishibashi Y, Umezawa S, Izumi H, Akizuki N, Ogawa A, . Feasibility and usefulness of the ‘distress screening program in ambulatory care’ in clinical oncology practice. Psychooncology 2010;19:718–25.

 PubMed Web of Science ®Google Scholar

Ito T, Shimizu K, Ichida Y, Ishibashi Y, Akizuki N, Ogawa A, . Usefulness of pharmacist-assisted screening and psychiatric referral program for outpatients with cancer undergoing chemotherapy. Psychooncology 2011;20:647–54.

 PubMed Web of Science ®Google Scholar

Grassi L, Rossi E, Caruso R, Nanni MG, Pedrazzi S, Sofritti S, . Educational intervention in cancer outpatient clinics on routine screening for emotional distress: An observational study. Psychooncology 2011;20:669–74.

 PubMed Web of Science ®Google Scholar