title: Incorporating patient-reported outcomes to improve emotional distress screening and assessment in an ambulatory oncology clinic.
abstract: OBJECTIVE
  Assessment of distress and well-being of patients with cancer is not always documented or addressed in a clinical visit, reflecting a need for improved psychosocial screening.
  
  
  METHODS
  A multidisciplinary team completed process mapping for emotional distress assessment in two clinics. Barriers were identified through cause-and-effect analysis, and an intervention was chosen. Patient-reported outcomes were collected over 6 months using the validated National Comprehensive Cancer Network Emotional Distress Thermometer (EDT) paper tool. The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) measures were compared before and after intervention.
  
  
  RESULTS
  During 6 months, a total of 864 tools were collected from 1,344 patients in two ambulatory clinics (64%). Electronic medical record documentation of distress increased from 19.2% to 34% during the 6 months before and after intervention. QOPI measures showed an increase in emotional well-being documentation. Of 29 new and 835 return patients, 62% indicated mild distress (EDT, 0 to 3), 18% moderate (EDT, 4 to 6), and 11% severe (EDT, 7 to 10). The average distress score of new patients was significantly higher than that of return patients (5.39 [n = 26] v 2.52 [n = 754]; P < .001). The top problems for patients with moderate and severe distress were worry, fatigue, pain, and nervousness; depression and sadness were particularly noted in patients reporting severe distress. Eleven percent of patients were referred to the social worker on site.
  
  
  CONCLUSIONS
  A pilot intervention collecting Patient-reported outcomes in two ambulatory clinics led to increase in psychosocial distress screening followed by sustained improvement, indicated by both process and QOPI measures.
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT anne.chiang@yale.edu.
authors: Anne C
authors: AC
authors: Chiang
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT.
authors: Stephanie
authors: S
authors: Buia Amport
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT.
authors: Diane
authors: D
authors: Corjulo
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT.
authors: Katherine L
authors: KL
authors: Harvey
authors: Smilow Cancer Hospital, Yale Cancer Center, New Haven, CT.
authors: Ruth
authors: R
authors: McCorkle
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards; D003237:Connecticut; D057286:Electronic Health Records; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D008603:Mental Health; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D010865:Pilot Projects; D011237:Predictive Value of Tests; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D000068217:Social Workers; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D057188:Workflow