Changing the culture for psychosocial care: Does it need changing?

70 Background: National organizations recommend routine screening for psychosocial distress in cancer patients. American College of Surgeons (ACoS) Commission on Cancer mandates screening for accreditation with requirements for timing/method/tool for screening; assessment/referral; and documentation.

METHODS: MD Anderson routinely screens patients for distress with policies and algorithms for the process. We sought to enhance this standard process by incorporating a dedicated psychosocial liaison in the clinic to ensure screening based on NCCN guidelines, follow-up with patients at the medical visit, and clear documentation and referral per ACoS standards. This study compared the standard process to the enhanced process (which occurred in parallel) through a 6-month retrospective chart review of Thoracic Center patients identified as distressed by either process.

RESULTS: The enhanced process utilized the Distress Thermometer (DT) cut-off > 4 resulting in optimal specificity (.77) and sensitivity (.64) compared to the standard process using > 6 (specificity = .87; sensitivity = .34). In the enhanced process (N = 71), 99% were seen during the clinic visit, compared to 13% in the standard process (N = 92) (Fishers Exact; P < .0001). In the standard process, 18% were contacted by phone, 10% were seen later while in-patient, and 33% received a phone message; for 26%, no note was dictated. In the enhanced process, there were high rates of documentation of assessments of suicide (100%), depressive symptoms (100%) and anxiety symptoms (96%) compared to the standard process where documentation occurred less often (suicide 5%; depressive symptoms 11%; anxiety symptoms 11%) (Fishers Exact; all P's < .0001).

CONCLUSIONS: Results support the institution's recent practice change to > 4 on the DT. The enhanced process utilizing a psychosocial liaison facilitates screening at the clinic visit and can support existing mental health providers who may have competing responsibilities. Findings also suggest having standards for distress documentation. Overall, the enhanced process fully meets ACoS standards in all required areas.