Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Psychooncology. 2020 Dec;29(12):2067-2074. doi: 10.1002/pon.5565. Epub 2020 Oct 10.
Guidelines recommend systematic evaluation of distress screening and referral for cancer patients. Implementation remains a notable gap for cancer centers serving disadvantaged communities. We present the implementation of a distress screening program within a Veterans Affairs hospital oncology clinic, serving a majority African American (AA) male population of low socioeconomic status (SES).
The Coleman Foundation funded this program supporting a palliative care physician and psychologist to implement screening in a phased approach as follows: (1) Organizing key stakeholders, (2) educating clinical staff, (3) delivering distress screening, (4) generating documentation, and (5) implementing clinical action and referral pathways. We utilized validated measures in the "Patient Screening Questions for Supportive Care" screening tool.
This program was unsuccessful in screening all veterans with cancer; however, we were able to implement 3 years of longitudinal screening. In distress screens from the initial program period (n = 253), patients were primarily males (95.6%) of older age (m = 70, standard deviation = 9.45), AA (76.4%), with various cancers of advanced disease (69%). Males reported moderate psychosocial distress and elevated financial needs. For males with elevated psychosocial distress (n = 63, PHQ-4 ≥3), 36% were previously connected with psychosocial services. Following screening, engagement increased as the majority (77%) established psychosocial care.
This screening program had mixed success. Centralized program staff and available supportive care referrals were critical for program implementation. Screening may have increased engagement in social work/mental health services for males of low SES. Screening programs should be tailored to the needs of underserved communities with accessible housing/food subsidies.
指南建议对癌症患者进行系统的困扰筛查和转介。对于为贫困社区服务的癌症中心来说，这一建议的实施仍然是一个显著的差距。我们介绍了在退伍军人事务部医院肿瘤诊所实施困扰筛查计划的情况，该诊所主要为社会经济地位较低的非裔美国男性（AA）群体服务。
科尔曼基金会为此项目提供资金支持，由一名姑息治疗医生和一名心理学家分阶段实施，具体如下：（1）组织主要利益相关者，（2）对临床工作人员进行教育，（3）进行困扰筛查，（4）生成文件，（5）实施临床行动和转介途径。我们使用了“患者支持性护理筛查问题”筛查工具中的经过验证的措施。
该计划未能对所有癌症患者进行筛查；然而，我们能够实施 3 年的纵向筛查。在初始项目期间的困扰筛查中（n = 253），患者主要为男性（95.6%），年龄较大（m = 70，标准差 = 9.45），为 AA 族（76.4%），患有各种晚期疾病的癌症。男性报告中度心理社会困扰和较高的经济需求。对于 PHQ-4≥3 的男性中具有较高心理社会困扰的患者（n = 63），36%之前曾接受过心理社会服务。筛查后，随着大多数患者（77%）建立了心理社会护理，参与度增加。
该筛查计划的实施效果喜忧参半。集中的项目工作人员和可用的支持性护理转介对于计划的实施至关重要。对于社会经济地位较低的男性，筛查可能会增加他们接受社会工作/心理健康服务的机会。筛查计划应根据服务不足社区的需求进行定制，提供可及的住房/食品补贴。
