a Graduate College of Social Work , University of Houston , Houston , Texas , USA.
b Kent School of Social Work , University of Louisville , Louisville , Kentucky , USA.
J Psychosoc Oncol. 2019 May-Jun;37(3):287-300. doi: 10.1080/07347332.2018.1523822. Epub 2019 Apr 2.
A growing recognition of the impact of distress on the quality of life and adherence to treatment of cancer patients has been documented. As a result, national guidelines and standards of care mandate providers to implement distress screening protocols to connect patients with psychosocial services. However, limited literature has examined whether distressed patients are referred to care and their needs addressed. This article assessed differences in rates of referral and psychosocial services by demographic factors, clinical characteristics, and distress severity. Potential predictors of these two outcomes were investigated.
A retrospective analysis of patient data abstracted from electronic medical records of a NCI-designated Academic Comprehensive Cancer Center was conducted. Of the 399 cases meeting the inclusion criteria, 302 (75.7%) were screened for distress with the Distress Thermometer. Differences were examined with chi-square, t-tests, and ANOVAs. Predictors were identified with multivariate logistic regressions.
Overall, patients who were identified as distressed were referred to a psychosocial provider (71.4%) and psychosocial services were delivered in approximately 64% of the cases. Referrals and service delivery rates varied by age group, clinic, health insurance coverage, distress severity, and presence of psychosocial issues. Only the distress score predicted the likelihood of being referred, and of a provider intervention to occur. Conclusions and implications for psychosocial providers: Although the protocol appeared to facilitate referral and service delivery to patients scoring above the cutoff for distress, our results suggest that patients were more likely to not have their distress and psychosocial needs addressed if they were older, without insurance coverage, and were seen in clinics where a social worker was not consistently available. Future studies able to monitor patient outcomes in terms of quality of life, satisfaction with care, and service utilization are recommended.
越来越多的人认识到困扰对癌症患者生活质量和治疗依从性的影响。因此，国家指南和护理标准要求医疗服务提供者实施困扰筛查方案，将患者与心理社会服务联系起来。然而，有限的文献研究了是否有困扰的患者被转介到护理中，以及他们的需求是否得到满足。本文评估了按人口统计学因素、临床特征和困扰严重程度划分的转介率和心理社会服务的差异。调查了这两个结果的潜在预测因素。
对一家 NCI 指定的学术综合癌症中心电子病历中患者数据进行回顾性分析。在符合纳入标准的 399 例患者中，有 302 例（75.7%）使用困扰温度计进行了困扰筛查。采用卡方检验、t 检验和方差分析比较差异。采用多元逻辑回归确定预测因素。
总体而言，被确定为困扰的患者被转介到心理社会服务提供者（71.4%），大约 64%的患者接受了心理社会服务。转介率和服务提供率因年龄组、诊所、医疗保险覆盖范围、困扰严重程度和存在心理社会问题而有所不同。只有困扰评分预测了被转介的可能性，以及提供者干预的可能性。结论和对心理社会服务提供者的意义：尽管该方案似乎促进了对评分高于困扰截止值的患者的转介和服务提供，但我们的结果表明，如果患者年龄较大、没有医疗保险覆盖范围，并且在没有社工的诊所就诊，他们的困扰和心理社会需求更有可能得不到满足。建议未来的研究能够监测患者在生活质量、护理满意度和服务利用方面的结果。
