IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Distress: Part II - Does...
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Transcript of IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Distress: Part II - Does...
Alex Mitchell www.psycho-oncology.infoPaul SymondsLorraine GraingerElena Baker-Glenn
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010IPOS 2010
0178 - Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians’ Communication, Judgement or Accuracy of Anxiety and Depression?
0178 - Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians’ Communication, Judgement or Accuracy of Anxiety and Depression?
Concepts of ImplementationConcepts of Implementation
Staff Recognition (unassisted)
Tool Validity (vs gold standard)
Tool acceptability
DetectionClinician managementPatient wellbeing
DetectionClinician managementPatient wellbeing
Before tool
After tool
Pilot tool
Baseline
Audit / Research ProtocolAudit / Research Protocol
Phase I – DT across LNR network (incl training)
Phase II – Enhancements to DT
Phase III - Screening plus Intervention
Phase I
Phase II
Phase II
8%
DT37%
DepT23%
AngT18%
AnxT47%
4%
7%
1%
1%
9%
3%
0%
2%
4%
15%
3%
2%
Nil41%
Non-Nil59%
DT
AnxT AngT
DepT
More than just “distress”More than just “distress”
Of 401 chemotherapy attendees
59% have an emotional complication (3v4)
37% (62% of 59%) it included distress
23% it excluded distress
Validity of DT vs depression (DSMIV)
SE 80% SP 60% PPV 32% NPV 93%
Local Study: Recognition by CNS in oncologyLocal Study: Recognition by CNS in oncology
Approached - 800 patients
Willing - 700
Assessed - 500
Returned - 402
Phase II Results – detection baselinePhase II Results – detection baseline
Comment: Slide illustrates diagnostic accuracy according to score on DT
11.815.4
30.4 28.9
41.9 42.9 40.7
57.1
82.4
66.771.4
15.8
25.0
26.124.4
19.4 19.0
33.3
21.4
11.8
22.2 14.3
72.4
59.6
43.546.7
38.7 38.1
25.921.4
5.911.1
14.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Zero One Two Three Four Five Six Seven Eight Nine Ten
Judgement = Non-distressedJudgement = UnclearJudgement = Distressed
Phase II Results Post ET (DT)Phase II Results Post ET (DT)
1. Does tool influence detections?
2. Does tool influence quality of care?
Graphical – Screening principles
Non-Depressed
Depressed
# ofIndividuals
Cut-Off
# ofIndividuals
Severity of Depression
HighLow
High Sensitivity >>>>
<<<< low Specificity
Pre Screen – Ability of Clinicians to DetectPre Screen – Ability of Clinicians to Detect
Before
Sensitivity Distress 49.7%
Sensitivity Depression 55.4%
Sensitivity Anxiety 41.7%
Sensitivity Anxiety or Dep 41.7%
Ability of Clinicians to Detect HealthyAbility of Clinicians to Detect Healthy
Before
Specificity Distress 79.3%
Specificity Depression 87.5%
Specificity Anxiety 81.9%
Specificity Anxiety or Dep 80.5%
Pre-Post Screen – Change?Pre-Post Screen – Change?
Before After
Change distress =>+5%
Change depression =>+3%
Change anxiety =>+4%
Qualitative benefitsQualitative benefits
DEPRESSION
38% of occasions reported useful in improving communication.
28.6% useful for informing clinical judgement
FURTHER READING:
Screening for Depression in Clinical Practice An Evidence-Based guide
ISBN 0195380193 Paperback, 416 pagesNov 2009Price: £39.99