Feasibility and usefulness of the 'Distress Screening Program in Ambulatory Care' in clinical oncology practice.
OBJECTIVE
Although the implementation of routine screening for distress is desirable, doing so is difficult in today's busy clinical oncology practice. We developed the 'Distress Screening Program in Ambulatory Care' (DISPAC program) as a practical means of screening for and facilitating the treatment of major depression and adjustment disorders in cancer patients. This study assessed the feasibility and usefulness of the DISPAC program in actual clinical situations.


METHODS
As part of the DISPAC program, nurses administered a psychological screening measure, the Distress and Impact Thermometer (DIT), to consecutive cancer patients visiting an outpatient clinic in the waiting room. The attending physician then recommended psycho-oncology service referral to all positively screened patients. We compared the proportion of patients referred to a psycho-oncology service during the DISPAC period with the usual care period.


RESULTS
Of the targeted 491 patients treated during the DISPAC period, 91.9% (451/491) completed the DIT; the results were positive in 37.0% (167/451), recommendations for referrals were given to 93.4% (156/167), and 25.0% (39/156) accepted the referral. Ultimately 5.3% (26/491) of the targeted patients were treated by psycho-oncology service as having major depression or adjustment disorders, a significantly higher proportion than during the usual care period (0.3%; p<0.001). The nurses required 132+/-58 s per person to administer the DIT.


CONCLUSIONS
The DISPAC program is useful for facilitating the care of cancer patients with psychological distress. Nevertheless, the acceptance of referrals by patients and the reduction of the burden placed on nurses are areas requiring improvement.
Shimizu
Ken
K
Psycho-Oncology Division, National Cancer Center Hospital, Chuou-ku, Tokyo, Japan.
Ishibashi
Yuki
Y
Umezawa
Shino
S
Izumi
Hideko
H
Akizuki
Nobuya
N
Ogawa
Asao
A
Fujiwara
Yasuhiro
Y
Ando
Masashi
M
Katsumata
Noriyuki
N
Tamura
Kenji
K
Kouno
Tsutomu
T
Shimizu
Chikako
C
Yonemori
Kan
K
Yunokawa
Mayu
M
Uchitomi
Yosuke
Y
D000275:Adjustment Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000523:psychology*; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D020380:Needs Assessment; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000473:pathology / Q000523:psychology*; D017060:Patient Satisfaction; D012017:Referral and Consultation; D012803:Sick Role; D011795:Surveys and Questionnaires