Psychosocial distress in vulnerable patient populations: What happens after screening?

114 Background: The Commission on Cancer mandates psychosocial distress screening for patients with cancer, as well as documentation of referrals made to address sources of distress. Patients in safety net settings, who are vulnerable to significant economic and social stressors, may benefit from such screening; however, it is unclear if patients can access needed services and if their needs change over time. We examined the experience of cancer patients in an urban safety-net healthcare system to identify areas of improvement in the provision of support services.

METHODS: We performed a retrospective cohort analysis of patients screened for psychosocial distress during 2015. We reviewed medical records from initial oncology visits for results of screening and referrals made at that time. Those who reported a distress score of ≥ 4 were eligible for telephone follow up, which occurred 1-12 months after initial screening. Patients who agreed to participate completed a telephone survey that assessed current distress and referral status.

RESULTS: Of 113 patients who completed a psychosocial distress screen, 60% (n=68) reported a distress score of ≥ 4 and were called for follow up. Of these 68 patients, 17 (25%) had died or enrolled in hospice, 16 (25%) could not be reached after 3 attempts, 7 (10%) had transferred care, and 1 declined to participate. 26 patients (38%) completed telephone follow up. Patients reported an average distress score of 3.8, compared to 6.2 at their first visit. While "worry" was the most commonly reported problem at baseline, "pain" was the most common problem at follow up. For these 26 patients, a total of 69 referrals were made at their first visit, 59% of which were not accessed. 58% of the reasons given for not accessing referrals cited factors other than lack of interest, including requiring more information, not hearing back from the organization, and transportation issues.

CONCLUSIONS: Significant barriers, such as difficulty with referrals and follow up, may interfere with providing care to a diverse, underserved population of patients who report high levels of distress at their first oncology visits. Alternative approaches, including primary or specialty palliative care, may be needed in this population.