Hui David, Titus Annie, Curtis Tiffany, Ho-Nguyen Vivian Trang, Frederickson Delisa, Wray Curtis, Granville Tenisha, Bruera Eduardo, McKee Donna K, Rieber Alyssa
Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Oncologist. 2017 Aug;22(8):995-1001. doi: 10.1634/theoncologist.2016-0500. Epub 2017 May 5.
Distress screening is mandated by the American College of Surgeons Commission on Cancer; however, there is limited literature on its impact in actual practice. We examined the impact of a pilot distress screening program on access to psychosocial care.
Edmonton Symptom Assessment System (ESAS) screening was routinely conducted at our community-based medical oncology program. Patients who screened positive for severe distress were sent to a social worker for triage and referred to the appropriate services if indicated. We compared the proportion of patients who had ESAS completed, the proportion of patients who screened positive, and the number of patients who had social work assessment and palliative care consultation over the preimplementation (September 2015), training (October/November 2015), and postimplementation (December 2015) periods.
A total of 379, 328, and 465 cancer patients were included in the preimplementation, training, and postimplementation periods, respectively. The proportion of patients who completed ESAS increased over time (83% vs. 91% vs. 96%). Among the patients who had completed ESAS, between 11% and 13% were positive for severe distress, which remained stable over the three periods. We observed a significant increase in social work referrals for psychosocial assessment (21% vs. 71% vs. 79%). There was also a trend towards an increased number of palliative care referrals (12% vs. 20% vs. 28%).
Our community-based cancer center implemented distress screening rapidly in a resource-limited setting, with a notable increase in symptom documentation and psychosocial referral.
The American College of Surgeons Commission on Cancer mandates distress screening; however, there is limited literature on how this process should be implemented and its impact on clinical practice. We used the Edmonton Symptom Assessment System for routine symptom distress screening in a community-based medical oncology program that provides care for an underserved population. Comparing before and after program implementation, we found an increase in the number of documentations of symptom burden and an increase in psychosocial referrals. Findings from this study may inform the implementation of routine symptom distress screening in cancer patients.
美国外科医师学会癌症委员会要求进行心理困扰筛查；然而，关于其在实际临床中的影响的文献有限。我们研究了一项心理困扰筛查试点项目对获得心理社会护理的影响。
在我们以社区为基础的肿瘤内科项目中，常规进行埃德蒙顿症状评估系统（ESAS）筛查。筛查出严重心理困扰阳性的患者被转介给一名社会工作者进行分诊，并在有指征时转介至适当的服务机构。我们比较了在实施前（2015年9月）、培训期（2015年10月/11月）和实施后（2015年12月）三个阶段中完成ESAS的患者比例、筛查阳性的患者比例以及接受社会工作评估和姑息治疗咨询的患者数量。
实施前、培训期和实施后阶段分别纳入了379例、328例和465例癌症患者。完成ESAS的患者比例随时间增加（83%对91%对96%）。在完成ESAS的患者中，11%至13%的患者存在严重心理困扰阳性，在三个阶段中保持稳定。我们观察到转介进行心理社会评估的社会工作转介显著增加（21%对71%对79%）。姑息治疗转介数量也有增加的趋势（12%对20%对28%）。
我们以社区为基础的癌症中心在资源有限的环境中迅速实施了心理困扰筛查，症状记录和心理社会转介显著增加。
美国外科医师学会癌症委员会要求进行心理困扰筛查；然而，关于该过程应如何实施及其对临床实践的影响的文献有限。我们在一个为服务不足人群提供护理的以社区为基础的肿瘤内科项目中，使用埃德蒙顿症状评估系统进行常规症状心理困扰筛查。比较项目实施前后，我们发现症状负担记录数量增加，心理社会转介增加。本研究结果可能为癌症患者常规症状心理困扰筛查的实施提供参考。
