1) The document discusses implementing a screening programme to detect cancer-related distress. It examines whether screening influences detection of distress and quality of care. 2) Results showed screening modestly improved detection sensitivity from 49.7% to 55.8% and specificity remained similar. Detection rates of distress, anxiety, and depression were higher after implementing screening. 3) Nurses reported screening helped communication with patients about psychosocial issues and informed clinical judgement, particularly for those with high distress.

1. T177 --Implementation of aaScreening Programme for Cancer
T177 Implementation of Screening Programme for Cancer
Related Distress:
Related Distress:
Part II--Does Screening Influence Detection of Distress?
Part Does Screening Influence Detection of Distress?
Alex Mitchell www.psycho-oncology.info
Paul Symonds
Lorraine Grainger
Elena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010
IPOS 2010

2. Concepts of Implementation
Staff Recognition (unassisted) Baseline
Tool Validity (vs gold standard) Pilot tool
Tool acceptability
Before tool
Detection
Clinician management
Patient wellbeing
After tool

3. Audit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention

4. Phase I

5. Phase II

6. Phase II

7. 1.00
0.90
0.80
Ten
0.70 Nine
Eight
0.60 Seven
Six
0.50
Five
Four
0.40
Three
Two
0.30
One
0.20
Zero
Comment: Slide illustrates scores on ET
0.10 tool
0.00
Distress Anxiety Depression Anger
Thermometer Thermometer Thermometer Thermometer

8. DepT
DT
23%
37%
4% 3%
3%
DT DepT
7% 1%
Non-Nil 8% 0% Nil
9%
59% 41%
4% 1%
AnxT 2% AngT
15% 2%
AnxT AngT
47% 18%

9. More than just “distress”
Of 401 chemotherapy attendees
59% have an emotional complication (3v4)
37% (62% of 59%) it included distress
23% it excluded distress
Validity of DT vs depression (DSMIV)
SE 80% SP 60% PPV 32% NPV 93%
Of 64 DSM-MDD 50 +ve on DT

10. Leicester: DT/ET Implementation T177 t680
800 Patients Approached
100 Not Willing (13%) 700 Patients Willing (87%)
TAU 500 Staff Willing (71%)
Screen Data 402 Data Collected (80%)
Detections before Detections after Care after

11. Phase II Results – detection baseline

12. 100.0
5.9
11.1
14.3
90.0 Comment: Slide illustrates diagnostic 21.4
accuracy according to score on DT 11.8
25.9
80.0 38.7 38.1
43.5 22.2 14.3
46.7
70.0 59.6
21.4
72.4
60.0 Judgement = Non-distressed
33.3 Judgement = Unclear
19.4 19.0 Judgement = Distressed
50.0
26.1
24.4 82.4
40.0
71.4
66.7
30.0
25.0 57.1
41.9 42.9 40.7
20.0 15.8
30.4 28.9
10.0
15.4
11.8
0.0
Zero One Two Three Four Five Six Seven Eight Nine Ten

13. Detection sensitivity = 50.6%
1.00
Detection specificity = 79.4%
Post-test Probability
Overall accuracy = 65.4%.
0.90
0.80
0.70
0.60
CHEMO+
0.50
CHEMO-
0.40
Baseline Probability
0.30 COMMU+
COMMU-
0.20
0.10
Pre-test Probability
0.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Comment: Slide illustrates performance of chemotherapy vs community nurses in oncology

14. Phase II Results Post ET (DT)
1. Does tool influence detections?
2. Does tool influence quality of care?

15. Pre-Post Screen - Distress
Before After
Sensitivity of 49.7%
Specificity of 79.3%
PPV was 67.3%
NPV was 64.1%

16. Pre-Post Screen - Distress
Before After
Sensitivity of 49.7% 55.8% =>+5%
Specificity of 79.3% 79.8% =>+1%
PPV was 67.3% 70.9% =>+4%
NPV was 64.1% 67.2% =>+3%
There was a non-significant trend for improve detection sensitivity (Chi² =
1.12 P = 0.29).

17. Screening a failure?

18. Clover, Carter et al (unpublished)
35
30
% patients over threshold
Distress
25
Pain
20
15
10
5
0
1 2 3 4 5 6 7 8
Quarter of screening
First occasion of screening (n=4543)

19. a. Communication
DISTRESS
43% of CNS reported the tool helped them talk with the patient
about psychosocial issues esp in those with distress
28% said it helped inform their clinical judgement
DEPRESSION
38% of occasions reported useful in improving communication.
28.6% useful for informing clinical judgement

20. Credits & Acknowledgments
Elena Baker-Glenn University of Nottingham
Paul Symonds Leicester Royal Infirmary
Chris Coggan Leicester General Hospital
Burt Park University of Nottingham
Lorraine Granger Leicester Royal Infirmary
James Coyne University of Pennsylvania
Nadia Husain Leicester General Hospital
Joanne Herdman Leicester General Hospital
Jo Kavanagh Leicester Royal Infirmary
For more information www.psycho-oncology.info