Implementation of Distress Screening and Referrals Among Oncology Outpatients Initiating Palliative Care

Abstract

Problem: 33 out of 105 (31%) oncology outpatients at an academic cancer center were documented to have symptoms of psychological distress (PD) during initiation to palliative care services, which can lead to decreased quality of life, nonadherence to treatment, and increased burden on healthcare staff if untreated. Purpose: To implement a distress screening and referral protocol for oncology outpatients through utilization of the Distress Thermometer and Problem List (DT) screening tool to identify individuals with significant distress (scores of four or greater) and guide healthcare providers in referral interventions. Methods: DT screenings for cancer outpatients initiating palliative care services were completed by a medical assistant via telephone within seven days of new referral appointments over a 16-week period; the palliative care provider was electronically notified of individuals with significant distress scores, including documentation of a problem list. The provider incorporated the distress scores into new patient evaluations and initiated additional referrals to interdisciplinary care teams, as indicated. Results: 53 patients were eligible for the intervention, 21 patients (40%) had distress screenings completed, 15 screened patients (71%) demonstrated scores for significant distress and referral documentation was completed for 44 (83% of total patients), including 87% of target patients with DT scores four and greater. 17 % of patients were not able to be reached via telephone and 2% of patients refused screening when called. Conclusions: Identifying patients with significant distress can guide healthcare workers in providing necessary interventions and resources for those suffering from PD. In this QI project, patient needs were primarily addressed by the palliative care provider for symptom management and advanced care planning. This project supports the need for palliative care resources in the outpatient cancer care setting.