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