Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas.
Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Psychooncology. 2019 Jan;28(1):61-67. doi: 10.1002/pon.4910. Epub 2018 Oct 29.
The prevalence of increased distress among cancer patients has been well established and is known to be associated with negative consequences. Limited research has examined the association between distress and utilization of services, however, which is critical to understanding whether measurements of distress are being used to optimize patient care in the context of cancer.
One thousand two hundred thirteen adult cancer patients completed the Distress Thermometer and Patient Needs Assessment early in their cancer care. Electronic medical record (EMR)-abstracted data included psychosocial service utilization in the 12 months following the completion of these psychosocial metrics. Logistic regressions followed by t tests were completed to assess if distress or unmet needs were affiliated with service utilization rates.
When controlling for age, distress significantly predicted service utilization rates overall. Follow-up t tests suggest that use of social work and registered dietician services was higher among those with distress scores greater than 6. When assessing unmet needs, utilization rates were positively associated with number of unmet needs, specifically for social work and dieticians.
Distress and unmet needs were related to higher rates of psychosocial service utilization during the 12 months following assessment of symptoms. These results support the continued mandate for evaluation of distress and suggest that psychosocial screening may be assisting in directing referrals and enhancing comprehensive care for patients. As psychosocial services grow, the need for continued evaluation is recommended to determine if psychology and chaplaincy services are utilized at higher rates as available providers increase.
癌症患者的痛苦增加的发生率已经得到充分证实，并且与负面后果有关。然而，有限的研究调查了痛苦与服务利用之间的关联，这对于理解在癌症背景下，是否正在利用痛苦的测量来优化患者的护理至关重要。
1213 名成年癌症患者在癌症治疗初期完成了痛苦温度计和患者需求评估。电子病历（EMR）摘录的数据包括在完成这些心理社会指标后的 12 个月内的心理社会服务利用情况。进行逻辑回归，然后进行 t 检验，以评估痛苦或未满足的需求是否与服务利用率相关。
在控制年龄的情况下，痛苦总体上显著预测了服务利用率。后续的 t 检验表明，在痛苦评分大于 6 的患者中，使用社会工作者和注册营养师服务的比例更高。在评估未满足的需求时，利用率与未满足的需求数量呈正相关，特别是对社会工作者和营养师而言。
在评估症状后的 12 个月内，痛苦和未满足的需求与更高的心理社会服务利用率相关。这些结果支持对痛苦进行持续评估的要求，并表明心理社会筛查可能有助于指导转介，并增强患者的综合护理。随着心理社会服务的增长，建议继续进行评估，以确定随着可用提供者的增加，心理学和牧师服务的利用率是否更高。
