title: What happens after distress screening? Patterns of supportive care service utilization among oncology patients identified through a systematic screening protocol.
abstract: While distress screening is important for identifying unmet needs of cancer patients, less is known about referral and uptake of supportive care services among distressed patients. The current analysis examined screen-based rates of referral to supportive care and explored demographic and clinical correlates of referral uptake.
  
  
  
  We tracked distress screens completed by a varied group of cancer patients receiving outpatient care at a National Cancer Institute (NCI)-designated cancer center during a 1-month period. Electronic medical record review was used to examine the rates of supportive care referral and uptake among distressed patients.
  
  
  
  Out of 644 unique screens, 195 (30 %) patients reported significant distress; distressed patients were more likely to be non-white (odds ratio (OR) = 1.71, p < 0.01), prescribed psychiatric medication (OR = 1.92, p < 0.00), and have no previous contact with the cancer center's supportive care staff (OR = 1.62, p = 0.01). Thirty-four of these patients pre-emptively declined supportive care contact; thus, 161 were referred for supportive care. Among the 99 patients who received initial assessments by a team member, only 19 (19 %) requested and completed at least one follow-up appointment.
  
  
  
  Findings from this analysis support earlier work demonstrating significant supportive care needs in cancer patients. However, it challenges the assumption that screening will result in increased uptake of supportive care services beyond initial assessment. Further work should focus on facilitating engagement and reducing barriers for patients with continuing post-assessment supportive care needs.
authors.affiliation: Oklahoma City VA Medical Center, 921 NE 13th Street, Oklahoma City, OK, 73104, USA. rachelfunkphd@gmail.com.|University of Texas Southwestern Medical Center, Dallas, TX, USA. rachelfunkphd@gmail.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Funk
authors.affiliation: Baylor University Medical Center at Dallas, Dallas, TX, USA.|University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Cassidy
authors.initials: C
authors.lastname: Cisneros
authors.affiliation: Washington DC VA Medical Center, Washington, DC, USA.|University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Rush C
authors.initials: RC
authors.lastname: Williams
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kendall
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.|University of Arizona, Tucson, AZ, USA.
authors.forename: Heidi A
authors.initials: HA
authors.lastname: Hamann
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment / Q000592:standards*; D009369:Neoplasms / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Cancer; Distress screening; Psychooncology; Supportive care
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