Rocque Gabrielle B, Taylor Richard A, Acemgil Aras, Li Xuelin, Pisu Maria, Kenzik Kelly, Jackson Bradford E, Halilova Karina I, Demark-Wahnefried Wendy, Meneses Karen, Li Yufeng, Martin Michelle Y, Chambless Carol, Lisovicz Nedra, Fouad Mona, Partridge Edward E, Kvale Elizabeth A
University of Alabama at Birmingham Comprehensive Cancer Center
Hematology and Oncology, University of Alabama at Birmingham School of Medicine
J Natl Compr Canc Netw. 2016 Apr;14(4):407-14. doi: 10.6004/jnccn.2016.0047.
There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear.
We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014.
Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress.
Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.
人们对癌症患者的心理社会护理和痛苦评估的兴趣日益浓厚。截至2015年，癌症委员会要求癌症中心对患者进行痛苦筛查，但最佳实施方法仍不明确。
我们评估了使用痛苦评估来构建外行人导航员与2014年1月1日至2014年12月31日期间参与导航的老年癌症患者互动的可行性和影响。
在我们的外行人患者导航项目登记的5121名患者中，4520名（88%）使用标准化痛苦工具（DT）完成了至少一次评估。导航员使用该工具进行正式和非正式的痛苦评估。在所有患者中，24%报告痛苦评分在4分或以上，5.5%报告痛苦评分在8分或以上。初次评估时最常见的痛苦来源是疼痛、平衡/行动困难和疲劳。少数族裔患者报告的痛苦来源与整个项目人群相似，与后勤问题相关的相对痛苦增加，如交通和财务/保险问题。当这些问题导致痛苦时，患者更有可能就保险/财务需求（79%）、交通（76%）以及饮食/营养（76%）和诊断（66%）方面的知识缺陷寻求帮助。
外行人导航员能够使用结构化痛苦评估以高普及率对患者痛苦进行常规筛查。
