Economic Evaluation of Screening for Distress: the 6th ... conference materials... · Danielle...
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Cancer Care – Tom Baker Cancer Centre Department of Psychosocial Resources Helping You Live Well With Cancer Education Research Clinical Care Economic Evaluation of Screening for Distress: the 6 th Vital Sign in Cancer Patients Danielle Baron BA MSc, Barry Bultz PhD, Shannon Groff BSc, Konrad Fassbender PhD 24 th Annual Palliative Care Conference – Edmonton October 28-29, 2013
Transcript of Economic Evaluation of Screening for Distress: the 6th ... conference materials... · Danielle...
Cancer Care – Tom Baker Cancer Centre
Department of Psychosocial ResourcesHelping You Live Well With Cancer
EducationResearch
Clinical Care
Economic Evaluation of Screening for Distress: the 6th Vital Sign in Cancer Patients
Danielle Baron BA MSc, Barry Bultz PhD, Shannon Groff BSc, Konrad Fassbender PhD
24th Annual Palliative Care Conference – Edmonton October 28-29, 2013
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Outline
• Background: prevalence of psychological distress in cancer patients
• Intervention
– Assessment methods
– Participant cohort
• Results
– Patients
– Staff
• Summary & update
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
BackgroundCanadian Cancer Society Statistics (2013)
– ~40% of Canadian women and 45% of men will develop cancer during their lifetime
– 62% of people are expected to survive for 5 years after their cancer diagnosis
1Carlson 2003; 2Carlson 2004; 3Zabora 1997; 4Vodermaier 2008
Psychological Distress
• Cancer presents a variety of challenges for patients• Physical, emotional, practical, informational, spiritual
• Prevalence of distress among cancer patients ~35-45% in North America1,2,3
© www.albertahealthservices.ca
• Despite this prevalence few cancer programs screen patients for distress• As of 2008 only 37% of 146 institutions in Canada were screening
cancer patients for distress4
Presenter
Presentation Notes
While diagnosis and treatment have an effect on the levels of distress experienced by patients, it is the initial psychological response upon diagnosis that is often the most relevant predictor of subsequent psychological distress As of 2008 only 37% of 146 institutions in Canada were routinely screening cancer patients for distress4 and only 54% of those screened more than once
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Overview
Tom Baker Cancer Centre - Calgary AB
• comprehensive cancer centre for Southern Alberta
• provides advanced medical and supportive cancer care
Integrated Symptom Relief Service (ISRS)
• paper-based checklist and ESAS at each outpatient visit and during treatment
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Methods of AssessmentPatients Staff
Tool Description Tool Description
ESAS1 9 common cancer symptoms on likertscale
Survey Done by frontline staff members who interact with patients
CPC2 Psychosocial, practical, and physical concerns; with additional 9 items
Focus Group Questions relating to knowledge about ISRS and how it has impacted patients
FACT–Br3 /H&N4
Self report to measure cancer-specific quality of life
EQ-5D5 Measure of health for clinical and economic appraisal
Survey Questionnaire related to satisfaction with treatment
Interview Semi-structured; one month after assessment (HSI)
1ESAS = Edmonton Symptom Assessment System; 2CPC = Canadian Problem Checklist; 3FACT–Br = Functional Assessment of Cancer Therapy – Brain (Cella2007a); 4FACT–Br = Functional Assessment of Cancer Therapy – Head & Neck (Cella 2007b); 5EQ-5D = EuroQol (EuroQol, 1990)
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Participant Cohort
Before After
91 Head & Neck 70
98 Neurological 88
189 Total 158
Implementation
N = 347
Before After
2010 2011
Presenter
Presentation Notes
Rationale for selection of population (effect size and SES)
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Participant Demographics:
• average age 59
• predominantly male (76%)
• most married (63%)
• predominantly Caucasian (85%)
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Preliminary ResultsMean service length
Group Mean Std Error Mean p value
Hours (min) Before 1.15 (69.0) .284 .041
After .74 (44.4) .102
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Health Care Encounters (per month)
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Edmonton Symptom Assessment System
Appetite
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Functional Assessment of Cancer Therapy (FACT)
p = .002
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Staff survey
“We have adequate time to discuss symptom management with patients.”
“The clinic provides comprehensive care to patients.”
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Summary
Patients
Decrease in number of encounters with providers ($)
Decrease in length of encounters ($)
Improvement in self-reports of appetite, breathlessness, and overall well-being ()
Increase in quality of life (Neuro Clinic) ()© http://marketingyourhospital.com
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Summary
Increase in comfort with adequate length of time per patient
Increase in confidence that clinic provides comprehensive care to patients
Frontline Staff
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Current State: October 2013
• Approximately 20 tumour groups at TBCC screening for distress; e.g., Lung, P&S, GI, Cutaneous, Brain/Bone Mets
• Alberta Radiosurgery Centre started screening all new consults Oct 1
• Long Term Survivorship Clinic went live Oct 4; Bone Marrow Transplant Clinic on Oct 15
• Respiratory Review Clinics went live Oct 15 for weekly review clinics with new palliative patients
Presenter
Presentation Notes
SFD has been integrated into general nursing orientation
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
Acknowledgements
Paula Jones, MAHarold Lau, MD, FRCPC(C)Jacob Easaw, MD, FRCP(C)Catriona Leckie, RN, MN, NP, CNN(C)Bejoy Thomas, PhD
Scott Blanchard, BA, BN, RNDan Charland, BAJohan Halland, BAAmy Waller, PhDLisa Shirt, RN, MN, CON(C)
This evaluation of Screening for Distress and an Integrated Symptom Relief Service was supported by a grant from the Advisory Committee of Research, Alberta Cancer Board and Alberta Cancer Foundation-
PI- Barry D Bultz
Department ofPsychosocial Resources
Helping You Live Well with CancerCancer Care – Tom Baker Cancer Centre
References• Canadian Cancer Society. Canadian Cancer Statistics 2013. Available at: http://www.cancer.ca/canada-
wide/about%20cancer/cancer%20statistics/canadian%20cancer%20statistics.aspx?sc_lang=en
• Carlson LE, Angen M, Cullum J, et al. High levels of untreated distress and fatigue in cancer patients. Br J Cancer. 2004;90:2297-2304
• Carlson LE, Bultz BD. Benefits of psychosocial oncology care: Improved quality of life and medical cost offset. Health and Quality of Life Outcomes. 2003;1
• Cella, D. (2007a). Function Assessment of Cancer Therapy-Br (FACT-Br): For patients with brain cancer. Retrieved from http://www.facit.org/FACITOrg/Questionnaires
• Cella, D. (2007b). Functional Assessment of Cancer Therapy-H&N (FACT-H&N): For patients with head & neck cancer. Retrieved from http://www.facit.org/FACITOrg/Questionnaires
• EuroQol (1990). EQ-5D. Rotterdam, Netherlands: EuroQol Group
• Vodermaier A, Linden W. Emotional distress screening in Canadian cancer care: A survey of utilization, tool choices and practice patterns. Oncology Exchange. 2008;7:37-40.
• Zabora J, Blanchard CG, Smith ED, et al. Prevalence of psychological distress among cancer patients across the disease continuum. J Psychosoc Oncol. 1997;15:73-87.
