Addressing the Psychological Distress of Cancer Patients Receiving Care at a Safety-Net Institution: A Retrospective Analysis of the Responsiveness of a Distress Screening Protocol

Background and Purpose. In recent years there has been growing recognition of the psychosocial impact of cancer on the quality of life and adherence to treatment of cancer patients. NCCN Guidelines and the Commission on Cancer Standards of Care mandate to implement distress screening protocols able to connect patients with psychosocial providers. However, limited information is available whether distressed patients are referred to care and their needs are addressed. Evidence to date suggests that cancer programs capacity for psychosocial care is moderate, with differences reported between community and NCI-designed centers, and for centers serving minority groups. The study examined the responsiveness of a distress screening protocol implemented at a safety-net institution as evidenced by referral and psychosocial response rates. Differences by demographic, clinical, distress characteristics and potential predictors of these two outcomes were investigated.

Methods. A retrospective analysis of the electronic medical record (EMR) of patients treated at a NCI-designated Academic Comprehensive Cancer Center (ACAD) was conducted. Of the 399 patients that met the inclusion criteria, 302 (75.7%) were screened for psychological distress with the Distress Thermometer (DT). Overall, patients were mostly middle-age non-Hispanic whites. Participants were from urban areas, had insurance coverage at the time of the study, and women were more represented in the sample than men. Lung, breast, and GU cancers were the larger cancer groups included in this study. Differences were examined with chi-square and t-tests. Multivariate logistic regressions with backward selection were used to identify predictors of referral and response from a psychosocial provider.

Results. Approximately 63% of patients scored above 4 on the DT. Distressed patients were referred to a psychosocial provider (73.2%) and elicited an action (65.8%). Patterns of referrals and psychosocial response varied by age, cancer type, distress score, and the presence of practical and emotional concerns, with younger patients, patients diagnosed with breast, lung, and head and neck cancer presenting significantly higher indications of referral and action taken. Higher distress score predicted the likelihood of being referred, while the psychosocial response of the provider was associated with insurance coverage, self-reported distress, and multiple psychosocial issues.

Conclusions and Implications. This retrospective analysis revealed that the implementation of a distress screening protocol appears to facilitate the referral to psychosocial care. However, there is the need to monitor and improve the responsiveness of the protocol, given that certain groups of patients were at risk of not being referred. Future studies should investigate strategies to better connect distressed patients with social workers and whether the utilization of psychosocial services results in improved patient outcomes.