Psychosocial Distress Management

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Nan Rothrock, PhD

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<ul><li> 1. Psychosocial Distress Management at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University<br />Nan Rothrock, PhD<br />Department of Medical Social Sciences<br />Northwestern University<br /></li></ul> <p> 2. Agenda<br />Guidelines for psychosocial distress screening<br />Barriers to screening<br />Pilot project at Lurie Comprehensive Cancer Center<br />Lessons learned<br /> 3. Distress<br />A multifactorial unpleasant emotional experience of a psychological cognitive, behavioral, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis. <br />National Comprehensive Cancer Network. NCCN Distress Management Guidelines version 1. 2011.<br /> 4. Increasing Attention on Screening for Psychosocial Distress in Cancer<br />Institute of Medicines Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs (2007)<br />Importance of distress screening <br />Importance of addressing psychosocial health in quality cancer care<br />NCCN <br />Distress should be recognized, monitored, documented, and treated promptly at all stages of the disease and in all settings<br />National Comprehensive Cancer Network. NCCN Distress Management Guidelines version 1. 2011.<br /> 5. Commission on Cancer<br />American College of Surgeons (ACoS) Commission on Cancer (CoC) 2012 Cancer Program Standards<br />The cancer committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care as the standard for patients with cancer<br />Oversight by psychosocial representative on cancer committee<br /> 6. CoC Requirements<br />Minimum frequency once per pivotal medical visit (eg, diagnosis, transitions in treatment, transitions off treatment)<br />Mode of assessment determined by program<br />Preference for standardized, validated tools with established clinical cutoffs<br /> 7. CoC Requirement (cont.)<br />Moderate/severe distress<br />Identify and examine the psychological, behavioral, and social problems of patients that interfere with their ability to participate fully in their health care and manage their illness and its consequences<br />After identifying needs, link to appropriate psychosocial services on site or by referral<br />Documentation in medical record (screening, referral/provision of care, follow-up)<br />IOM Report. 2007.<br /> 8. HOW?<br /> 9. Barriers<br />How do I measure distress?<br />How do I know what level of distress warrants follow-up? <br />How do I get that information to someone <br />who can do something about it?<br /> 10. Measurement<br />MANY distress measures (Distress Thermometer, Hospital Anxiety and Depression Scale [HADS], Patient Health Questionnaire [PHQ]-9, etc)<br /> 11. Single-Item Distress Thermometer<br />Quick, easy, but not always sufficient<br />Butt Z, et al. J Pain Symptom Manage. 2007; 35:20-30.<br /> 12. Measurement<br />Ideal measure: brief, precise, covers relevant issues in cancer<br />How can you be brief AND comprehensive?<br />Computer Adaptive Tests (CATs)!<br /> 13. <br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />Item<br />1<br />Item<br />2<br />Item<br />3<br />Item<br />4<br />Item<br />5<br />Item<br />6<br />Item<br />7<br />Item<br />8<br />Item<br />9<br />Item<br />n<br />100<br />50<br />0<br />Physical Functioning Item Bank<br /></p> <ul><li>Are you able to run 5 miles? </li></ul> <p> 14. Are you able to run or jog for 2 miles? 15. Are you able to walk a block on flat ground? 16. Are you able to walk from one room to another? 17. Are you able to stand without losing your balance for 1 minute? 18. Are you able to get in and out of bed?</p>