Purpose: The importance of psychosocial care for veterans with cancer highlights the need for a systematic approach to screening for psychosocial distress. A multidisciplinary team at the Comprehensive Cancer Center (CCC) at the VA Connecticut Healthcare System in West Haven, Connecticut, has formalized a process of distress screening.
Methods: We will present data from the first year of screening, including (1) patterns of distress in veterans with cancer, including (a) changes over time; and (b) patterns related to type/stage of malignancy; (2) impact of screening on number of referrals/completed consults to members of the multidisciplinary team; and (3) whether patterns in consults/referral changed after the addition of a computerized template to capture screening data in our medical record. This project was reviewed by our local Human Investigation Committee and deemed to be quality improvement and exempt from review. Patients receiving services within the CCC completed a distress screening form at each visit. Completed screens were documented in the CPRS in a computerized template and entered into a database. Data will be extracted from the cancer registry and from the medical record on type and stage of malignancy, demographic variables, and on number and types of consults generated and completed for each veteran with at least one completed screen.
Preliminary Results: Five hundred unique veterans were screened in year 1. Valid distress scores were available for 397 patients. One hundred five veterans had documented screens at 2 time points (T1 and T2), which are separated by a mean of 85.9 days (SD = 65.77). Mean distress score at T1 was 3.01 (SD = 3.01). At T1, 169 (40.3%) rated distress as > 4; and 134 (33.8%) rated distress as > 5. The mean distress score T2 was 3.01 (SD = 3.09). At T2, 27 (34.2%) rated distress as > 4; and 24 (30.4%) rated distress as > 5. Twenty-two (31%) increased from T1 to T2 with 16 (72.7%) increasing to > 4. Six (8.5%) were below clinical cutoffs at T1 but > 4 at T2. Twenty-two (31%) decreased from T1 to T2; 19 (86.4%) decreased to < 3. Twenty-seven (38%) did not change from T1 to T2. Distress screening resulted in an increase in consults to members of the multidisciplinary team (Clinical Health Psychology, Nutrition, Physical/Occupational Therapy, and Social Work). Nine consults were performed per month prescreening vs 14.4 per month after start of screening vs 22.75 per month after the addition of the computerized screening template in CPRS. Data on types of problems, relationship to type/stage of malignancy, and additional detail on pattern of consults will be presented.
Conclusions: Rates of clinically significant distress among veterans treated at the VA Connecticut Healthcare System are on par with rates noted in the literature. Distress measured by National Comprehensive Cancer Network Distress Thermometer changes over time highlighted the need for routine screening. The impact of screening on medical center resources as evidenced by the number of referrals to members of the multidisciplinary team and completed consults will be examined.