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Abstract
Background: A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated.
Methods: A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions.
Results: Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur.
Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.
Acknowledgments
The authors thank Eric Schneider, MPA and Richard Wagner, L.P.C., L.M.H.C. for their assistance with the data collection and data management. Supported by the Association of Oncology Social Work (AOSW), Oakbrook Terrace, IL.
Disclosure statement
The authors declare that the research was conducted in absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Notes
1 For this manuscript, “adherence” to the distress screening protocol was assessed according to the definition provided by Zebrack et al.;Citation15 with adherence evidenced by the presence of a note indicating that the screening has occurred, a scanned or photocopied copy of the DT, or a defined field in the electronic record with a score present.