Centre for Psycho-Oncology Research and Trainig, Division of Behavioural Sciences, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China.
LKS Faculty of Medicine Jockey Club Institute of Cancer Care, The University of Hong Kong, Hong Kong, SAR, China.
Psychooncology. 2024 Jan;33(1):e6261. doi: 10.1002/pon.6261. Epub 2023 Dec 4.
This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress.
Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time.
Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p < 0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline.
Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.
本前瞻性、单臂、实用实施研究通过评估（1）症状困扰筛查（SDS）的接受率、（2）SDS 病例的流行率、（3）社区心理社会支持服务的接受率，以及（4）转介心理社会支持服务对减轻症状困扰的效果，评估了在常规肿瘤治疗后门诊中嵌入护士主导的症状筛查计划的可行性。
我们使用改良的埃德蒙顿症状评估系统（ESAS-r）对最近完成癌症治疗的患者进行筛查。对筛查出有中重度症状困扰的患者进行转诊，转至由护士主导的社区为基础的症状管理计划，该计划涉及使用预定义分诊系统的阶梯式症状/心理社会管理干预。在此之后的 3 个月和 9 个月进行重新评估。主要结局包括 SDS 的接受率、SDS 病例的流行率、干预措施的接受率以及 ESAS-r 评分随时间的变化。
总体而言，2988/3742（80%）名符合条件的患者同意进行 SDS，其中 970 名（32%）报告有≥1 个 ESAS-r 症状为中重度（病例）。所有病例均接受了心理教育材料，673/970（69%）接受了心理社会支持服务转介。在完成两次评估的 328 名患者中，ESAS-r 评分随时间显著改善（p<0.0001）；整个研究过程中，101 名（30.8%）患者仍为 ESAS 病例，112 名（34.1%）在基线后 3 个月时恢复，另外 72 名（22%）在基线后 9 个月时恢复，而 43 名（12.2%）在基线后 9 个月时又恢复为 ESAS 病例。
在癌症患者中，具有完善转诊途径和持续监测的护士主导的 SDS 计划是可行且可接受的，可能有助于减轻症状困扰。我们打算下一步为 SDS 在常规癌症护理服务中的实施和转诊制定最佳策略。
