Distress Screening of Hematology Patients in a Hospital-Based Outpatient Setting and the Implications for Clinical Practice: A Quality Improvement Project

Abstract

Background: Cancer-related distress is a complex psychosocial phenomenon that often has negative consequences. Increased distress in cancer patients has been associated with longer hospital stays, poorer treatment compliance, and poorer clinical outcomes. Current research shows that cancer patients’ psychosocial distress is not routinely and consistently addressed and managed. |Purpose: The purpose of this quality improvement project was to adopt into clinical practice the current evidence-based distress screening guidelines from the National Comprehensive Cancer Network (NCCN) in order to provide holistic care to hematology patients. Sample/Setting: The setting was the hematology hospital-based outpatient practice of a large Midwestern tertiary healthcare center. The sample included 49 English-speaking patients ages 30-84 with a hematologic cancer diagnosis who were seen weekly during the implementation period (September— December 2019).|Methods: Patients were screened by nursing staff utilizing the NCCN Distress Thermometer (DT) and associated Problem List. The DT is scored zero (none) to 10 (extreme) to provide an assessment of the patient’s cancer-associated distress.|Results: Of the patient sample (n=49), the average age was 61.1 (SD 12.0). 61.2% were male (n=30) with a primary diagnosis of Non-Hodgkin Lymphoma (n=18, 36.7%), without a concomitant secondary diagnosis (n=44, 89.8%), diagnosed within the last 6 months (n=18, 36.7%), not receiving active treatment with chemotherapy (n=19, 38.8%), and had never been screened prior to this project. Reported median DT score was 2. For patients who reported DT scores ≥ 4 indicating moderate to severe distress (n=13, 26.5%), educational resources were provided according to highest-rated sub-category (emotional resources n=8, physical resources n=4, family resources n=1, spiritual resources n=0). There were no statistically significant differences in overall DT scores based on age, gender, cancer diagnosis, and current line of therapy.|Conclusion: This project demonstrates the importance of evaluating distress with the NCCT DT so that appropriate strategies can be implemented.