Adherence to Distress Screening Protocols Lacking

Adherence to screening protocols for routine distress screening at cancer centers resulted in fewer emergency department visits and hospitalizations in the 2-month period after the screening, according to the results of a study published in the Journal of the National Comprehensive Cancer Network.

According to Brad Zebrack, PhD, MSW, MPH, from the University of Michigan School of Social Work and the University of Michigan Comprehensive Cancer Center, utilization of distress screening protocols, such as the National Comprehensive Cancer Network Distress Thermometer, has the ability to uncover incapacitating conditions that, left untreated, could have an incredibly negative effect on patient outcomes.

“Appropriate screening and identification of distress would flag a referral to a social worker, whose clinical assessment would uncover the cause of the patient’s distress and lead to clinical engagement and delivery of an appropriate, evidence-based intervention, complementary to clinical treatment,” Zebrack said.

In the study, oncology social workers at Commission on Cancer–accredited cancer programs reviewed the electronic health records (EHRs) for their programs during a 2-month period in 2014. Adherence to distress screening protocols were based on documentation within the EHR that showed that screening and an appropriate clinical response had occurred.

The review of 8,409 EHRs from 55 centers showed an overall adherence rate of 62.7%. Adherence rates varied by institution and patient characteristics. For example, adherence was higher in community cancer programs (76.3%) compared with NCI-Designated Cancer Centers (43.3%). High rates of adherence were found in patients identified as black/African American (70.5%), and the lowest rates were seen in patients of American Indian/Alaska Native/Native Hawaiian/Pacific Island descent (45.7%). Additionally, patients aged 15 to 39 years were significantly less likely to be in adherence for screening compared with older patients.

“Particularly concerning is the finding that documentation of psychosocial screening is lacking in 1 of every 3 cases in this representative sample,” the researchers wrote. “The absence of these clinical data can compromise the ability of oncology care providers to know whether patients are receiving the psychosocial care and support they need when they need it.”

When screening protocols were followed, 12.8% of patients reported to have used the emergency department compared with 15.7% of patients for whom protocol was not followed. Similarly, when protocol was followed, 18.6% of patients were hospitalized at least once in the subsequent 2 months compared with 23.5% of patients who were not screened.

After controlling for independent effects of institutional or patient characteristics, the risk ratio for emergency department use indicated an 18% reduction in the likelihood of use among patients in adherence with the protocol (0.82). The risk ratio for hospitalization indicated a 19% reduction in the likelihood of use seen with adherence (0.81).

The researchers noted that “the findings are not intended to suggest that screening adherence causes reductions in service utilization, because the study is limited by its cross-sectional design, modest rates of missing data (although comparable to studies using EHRs), lack of detailed patient data, and variation across participating cancer programs in terms of the complexity of cases treated.”