Using an Integrated Care Model to Conduct Psychosocial Distress Screening

Background: CAMC Cancer Center is the largest comprehensive cancer center in West Virginia (WV), serving a rural and Appalachian population. The CARE Team consists of 4 nurse and 2 financial navigators, 1 clinical psychologist, 1 social worker, and 1 dietitian. Having a multidisciplinary team to assess and treat patients’ source of distress provides whole-patient care.^1,2

Objectives: Restructure the current distress screening process to increase referrals to CARE Team and decrease follow-up time. Create a referral network to rural psychosocial services. Audit medical records.

Methods: Patients are screened at every medical oncology visit using a Modified Distress Thermometer, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-7. Medical assistants input screeners and manually refer patients. Patients who do not request same-day services receive a follow-up phone call. Charts were audited for positive distress screeners, referrals, and follow-ups. CARE Team members led staff and physician training, mock patient walk-throughs, and also worked with the WV Cancer Coalition to develop a list of psychosocial services available.

Results: A review of 689 charts depicted a lag in follow-up time, poor documentation of rationale of missing screeners, and patient’s request for services. After training and offering same-day services, follow-up time and documentation improved significantly, although these changes were not maintained over time. Barriers included inability of the EHR to autotask or set reminders and identify the source of low follow-up rate (task appropriately vs problems contacting patient). Adoption of Cerner EHR in September 2016 may eliminate these barriers.

Conclusion: Staff and physician buy-in is often a barrier,³ and linking distress screening to the Quality Oncology Practice Initiative and accreditation help. Repeated clinical staff training is necessary as low confidence and insufficient training is a challenge to implementation.⁴ Staff need to know their role in distress screening and skills to introduce screening, referrals, and alert oncologists. Even when patients refused referrals offered by the MA, many patients accepted a CARE Team referral when advised by their oncologist. The primary treatment team can access psychosocial notes, making communicating with the primary treatment team seamless, a necessary step in whole-patient care.³ Asking patients if they want help is key as patients want control over their help seeking.⁵ Many left without seeking immediate help but would access services at their next visit.

Note: Funding for this project provided by the Screening for Psychosocial Distress Program, R25CA177553; R. McCorkle, PI, and also CAMC Health System. This project was presented as a poster at the American Psychosocial Oncology Society (APOS) Convention in March 2016.Chart audits conducted by Britni Ross, MA, and Elise Edwards, MA.

References

1. Pirl WF, Fann JR, Greer JA, et al. Recommendations for the implementation of distress screening programs in cancer centers: report from the American Psychosocial Oncology Society (ACOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force. Cancer. 2014;120:2946-2954.
2. Loscalzo M, Clark K, Pal S, et al. Role of biopsychosocial screening in cancer care. Cancer J. 2013;19:414-420.
3. Lazenby M, Erocolano E, Grant M, et al. Supporting commission on cancer–mandated psychosocial distress screening with implementation strategies. J Onc Pract. 2015;11:e413-e420.
4. Mitchell AJ, Waller A, Carlson LE. Implementing a screening programme for distress in cancer settings: science and practice. Psicooncolgía. 2012;9:259-275.
5. Clover KA, Mitchell AJ, Britton B, et al. Why do oncology outpatients who report emotional distress decline help? Psychooncology. 2014;24:812-818.