Background: The Institute of Medicine (IOM) 2013 report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from the NCCN Distress Problem List, IOM report, and CoC standards, with validated subtools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue, and physical function.1,2 Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public, and 1 safety net). Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (P <.0001).3 Participating sites voiced concerns about the 3 spiritual questions on the screening tool because they were worded to be triggered by a “No” response rather than a “Yes” response.
Objective: Assess spiritual questions on the Coleman Supportive Oncology Screening Tool and identify opportunities to improve the spiritual screening questions and navigation to spiritual resources.
Methods: The Coleman Supportive Oncology Collaborative (CSOC) analyzed patient answers to 3 spiritual questions in the CSOC screening tool at 2 cancer treatment sites (1 public and 1 academic). Descriptive statistics were used. CSOC nurses/navigators conducted discussions with chaplains to identify improved screening options as supported by recent literature.
Results: The CSOC screening tool was completed by 512 patients. The question “I have a sense of purpose or meaning” received an answer of “No” by 22.7% (116/512) of patients; the question “I feel peaceful” received an answer of “No” by 19.1% (98/512) of patients; and the question “I find strength in my faith and beliefs” received an answer of “No” by 11.5% (59/512) of patients. Additional analysis identified that 73% (72/98) of patients who answered “No” to the “I feel peaceful” question also answered “No” to 1 or 2 of the other spiritual questions. Of the remaining 26 patients, 16 patients had a PHQ-4 score of 3 or higher that triggered a navigation to psychosocial support; 8 patients with a PHQ-4 score lower than 3 stated “Yes” to practical/family concerns that triggered navigation to psychosocial support. The remaining 4 patients (<1% of 512), all had other concerns indicated on their screening tool (nutrition, treatment/care, or physical concerns) that triggered further staff navigation. CSOC chaplains encouraged rewriting screening questions to align with the paper by King et al,4 “Determining Best Methods to Screen for Religious/Spiritual Distress.” The suggestion was to remove the “I feel peaceful” question and reword the other 2 questions to be triggered by “Yes” responses.
Conclusions: Based on data analysis and spiritual literature, the CSOC navigators, chaplains, nurses, social workers, palliative care physicians, and psychologists adjusted the screening tool. The 3 spiritual questions were replaced with “Do you struggle with the loss of meaning and joy in your life?” and “Do you have religious or spiritual struggles?” that trigger navigation with a “Yes” response. Revised questions are under pilot testing at 3 cancer centers.
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