Purpose: Distress screening (DS) of cancer patients is likely to improve access to supportive care services and adherence to cancer treatment.
Background: We assessed DS at the CAVHS and the University of Arkansas for Medical Sciences by completing Quality Oncology and Practice Initiatives (QOPI) survey. At baseline, we identified assessment of distress screening in only 15% of patients compared to the national average of 50%.
Methods: Based on QOPI data, we performed 3 Plan-Do-Study-Act (PDSA) cycles. We implemented a DS template on computer patient record system (CPRS) at the CAVHS hematology-oncology clinic, validated the template after initial use, and modified it in each PDSA cycle.
Results: At baseline DS was identified in 18 out of 121 charts (15%) per QOPI survey results in 2013 Spring Round. During our first PDSA cycle, we decided to add DS templates to all electronic medical notes in CPRS. We validated the template in 20 patient charts. Thereafter, in the second PDSA cycle, we modified the template and included distress thermometer (DT). After this intervention, we noted distress screening in 27 of 100 charts from 14 providers. Out of these 27 patients, 4 had a distress score of 4 or greater; these patients were all referred to subspecialty services. We did a third PDSA cycle and DS improved to 46% (51 out of 111 charts) on QOPI 2015 Spring Round. Subsequently, we added daily reminders at staff meetings, weekly e-mail reminders, and visual DT in each clinic room to perform DS and improved DS to 55 screenings out of 100 charts audited (27% to 55%). In these patients, only 1 had score of 4 and 7 had scores of 3. Intervention was offered in 15 out of 55 (27.2%) patients including counseling and referral to subspecialty services.
Conclusion: Distress screening is important for identifying patients who need intervention. QOPI is an excellent method of evaluating compliance to distress screening and PDSA cycles are effective in improving compliance. We improved DS by more than 200% using QOPI, PDSA and other quality improvement methods.