• Implementation of a Distress Screening and Management Protocol for Adult Cancer Patients

      Uzupus, Allison M.; Edwards, Lori A. (2021-05)
      Problem: Approximately 50% of cancer patients experience clinically significant cancer-related distress. Unmanaged distress has been linked to decreased medication adherence, increased visits to the emergency room and oncology clinic, increased hospital stays, decreased quality of life and decreased overall survival. At a university-based cancer center in the mid-Atlantic region, informal assessment of patient distress was provider dependent and as a result was inconsistently conducted and documented. Purpose: The purpose of this quality improvement (QI) project was to implement a systematic screening protocol for distress which included a screening tool, staff training, as well as referral processes to identify and manage distress in adult patients with metastatic colorectal cancer. Methods: The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List (DT&PL) was integrated into the patient portal as a questionnaire and sent to patients with metastatic colorectal cancer prior to treatment to be completed prior to their infusion appointment. Infusion nurses reviewed the distress screening with patients during their appointment and made appropriate referrals to clinic-embedded resources such as social work, psychiatry, pain and palliative care, and/or pastoral care based on questionnaire results. Results: The NCCN DT&PL was successfully integrated into the portal as a questionnaire. Overall, 64% of patients completed the questionnaire at least once and 39% of the completed screens indicated high distress. All patients who indicated high distress had documented nursing interventions and/or referrals. Conclusions: Evidence-based distress screening and referral is a feasible practice change to improve patient outcomes. Key facilitators were integration into the electronic health record and personnel to support to initiative.
    • Screening for Diabetes-Related Distress in an Outpatient Endocrine Clinic

      Grandison, Jheneale R.; Callender, Kimberly (2021-05)
      Problem: Identification and treatment of diabetes-related distress (DD) are essential for diabetes management, quality of life, and reducing health care costs for people with diabetes. There was no standardized workflow for DD screening in an outpatient endocrine clinic that manages approximately 2000 persons with diabetes. Purpose: The purpose of this quality improvement (QI) project was to implement a screening and referral program for DD in an outpatient endocrine clinic. Methods: The QI project was implemented between August 31, 2020 – December 7, 2020. DD was measured using the Problem Areas in Diabetes-5 (PAID-5) scale (0 – 20) points. An ambulatory systems analyst created a flowsheet in Epic for the PAID-5 questionnaire and routed the PAID-5 to MyChart. Patients completed the PAID-5 on MyChart one week before the appointment or in-person during the encounter. Providers referred individuals with a PAID-5 score ≥ 8 to a mental health provider (MHP). Pre-and-post analysis of PAID-5 scores assessed for the reduction of PAID-5 scores and A1C values. Results: The PAID-5 screening compliance was 72% (n = 744/1028). It was identified that 31% (n = 228) had a PAID-5 score ≥ 8. Of those 228, only 24% received a referral to a MHP. Half the patients refused a referral, and 7% were already seeing a MHP. The average PAID-5 score was 5, and the baseline A1C value was 8% (< 5.7%). Conclusions: Screening for DD in adults with diabetes utilizing the PAID-5 questionnaire is feasible and can facilitate the referral of distressed patients to MHP’s. Long-term implications for the practice change include a holistic and comprehensive approach to the management of diabetes and diabetes-related outcomes, including reduction of A1C values in individuals referred to a MHP.