Implementing systematic distress screening in breast cancer
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Non-technical overview of the research topic and relevance to breast cancer: Many breast cancer patients experience psychological distress during their cancer care journey. Up to half of all newly diagnosed patients report distress in the first year of treatment. There are effective treatments for breast cancer patients experiencing distress, such as individual or group therapy, health education, and medication. Unfortunately, oncologists may not be aware of the symptoms of distress in their breast cancer patients, and some breast cancer patients who could benefit from referral to behavioral health specialists are overlooked. New guidelines recommend that all cancer patients be regularly screened for distress. However, there are unanswered questions about the impact of distress screening conducted on such a large scale. Few studies have evaluated the impact of distress screening on important outcomes in breast cancer patients, such as patient experience, symptom management, and use of health care services, as compared to the usual care offered by the health care organization. In addition, oncology clinicians are uncertain about the benefits of large-scale distress screening, and pilot screening programs have not been uniformly successful, particularly in the community oncology setting. There is a critical need to assess the effectiveness of distress screening programs in improving identification of distress, referral for services, and outcomes for breast cancer patients in real-world community oncology settings. This research will also provide insight into how we can best implement distress screening programs to meet the needs of breast cancer patients nationwide.
 
 
 
 The question(s) or central hypotheses of the research: Our overarching goals are to assess the effectiveness of the recommended distress screening program from the joint task force of the American Psychosocial Oncology Society, Association of Oncology Social Work, and Oncology Nursing Society on improving identification and referral to treatment for highly distressed breast cancer patients, and to assess patient-reported outcomes, health services utilization, and implementation outcomes of the program. We will address two main questions: 1) Is a community-oncology based, large-scale distress screening program more effective than usual care on improved identification of distressed patients, referral to behavioral health services, and patient-reported outcomes for breast cancer patients? 2) What are the barriers, facilitators, and other implementation-related outcomes related to distress screening in the community oncology setting?
 
 
 
 The general methodology: The setting for this research is Kaiser Permanente Southern California (KPSC), a large, integrated health care system with 14 medical centers. We will use a novel study design that allows us to study both the effectiveness of the distress screening program and implementation-related outcomes. We will use mixed methods, collecting both qualitative data from interviews and quantitative data from surveys and electronic health records. We will use a randomized design evaluate the effectiveness of the recommended distress screening program, introducing the program at some KPSC medical centers but not others. This allows for unbiased comparison of the effectiveness of the program between patients who receive it and those who do not. We will collect survey data to evaluate patient-reported outcomes, and access referral and health care use from the KPSC electronic medical record. We will then conduct interviews with breast cancer patients and clinicians to better understand the barriers and facilitators to implementation of the program during the trial. Next, we will evaluate the implementation-related outcomes of the program with a survey, and will include questions about what went well and what could have been done differently.
 
 
 
 Innovative elements of the project: This project is innovative in several ways. We will be studying the translation of a new guideline recommendation into clinical practice, which is a neglected but critical area of research. We are using a novel study design that allows us to evaluate both the impact and the implementation of distress screening. In addition, the setting of this research is a large, integrated system, allowing us to access long-term data on our patients. KPSC also has a very diverse membership, better representing the true population of breast cancer patients. Results from this work will help to improve the quality of care and quality of life for breast cancer patients throughout California and across the nation.