Using the distress thermometer to guide electronic referrals to psychosocial services.

Purpose: Evaluate a new administration protocol of the distress thermometer (DT) and assess its use in guiding electronic referrals within the medical record.Design: Data were gathered as part of a quality improvement project.Sample: Any patient within Saint Luke's Cancer Institute from March of 2016 to December of 2017.Methods: The DT was administered at every appointment with surgical and medical oncology and on Mondays while completing radiation. A referral to supportive services was offered to any patient scoring a 4 or above.Findings: Referrals to all supportive services increased by 69%. Staff adherence to distress screening guidelines increased to 95.42% and patient refusal to accept referrals fell to 2.72%.Conclusion: Administering the DT on a more regular basis and utilizing the DT to guide electronic referrals is achievable and results in increased referrals to supportive services.Implications for psychosocial providers or policy: Utilizing the DT in this manner can increase the number of patients identified and treated for distress.

Significance of Nonphysical Predictors of Distress in Cancer Survivors.

BACKGROUND: The Distress Thermometer (DT) is a well-validated tool that is frequently used in patients with cancer to screen for general distress and to generate referrals. However, a majority of the DT problem list items relate to physical concerns; this may lead to psychosocial issues being overshadowed. OBJECTIVES: The purpose of the current study is to examine the endorsement rates for nonphysical items, as well as the relationship between these items and overall DT scores. METHODS: A multiple logistic regression analysis of the first-time distress rating scale of 1,209 patients from 2005-2009 was conducted to determine whether nonphysical items on the DT significantly contributed to a patient falling into one of two categories. FINDINGS: This study provides evidence that emotional variables are particularly significant for patients who are at risk for distress and, consequently, should be prioritized for intervention when endorsed on the DT problem list.

Effect of methylphenidate on fatigue in women with recurrent gynecologic cancer.

OBJECTIVE: Fatigue is the most common and often the most bothersome complaint of individuals who are treated for cancer. One intervention now commonly suggested to treat fatigue is the use of psychostimulant medication. Early studies indicate some success in individuals with a mixed cancer diagnoses. This study evaluates the effect of methylphenidate on fatigue in women with recurrent gynecologic cancer. METHOD: Thirty-two women treated for recurrent gynecologic cancer were prescribed methylphenidate at morning and noon over a 8-week period. Participants completed the Fatigue Symptom Inventory (FSI) along with assessments of quality of life and mood at baseline, week 2, 4 and 8 to determine changes in levels of fatigue experienced. RESULTS: Patients reported significant declines in fatigue (p=0.0001), and improvement in both mood (p=0.0020) and quality of life (p=0.0351) when comparing baseline scores to study end. CONCLUSIONS: This study provides support for the use of a psychostimulant to treat fatigue in women who have recurrent gynecologic cancer. It is particularly relevant for these patients with incurable disease who are facing the end of life.

Distress in women with gynecologic cancer.

OBJECTIVE: The NCCN Distress Thermometer (DT) was administered to 143 women undergoing chemotherapy for gynecologic cancer over a two-year period. This report describes the frequency and character of psychological distress in this population and examines the effect of disease, treatment, and demographic variables on levels of distress. METHOD: The DT is a self-administered scale for patients to rate their level of distress from 0 to 10, where 0 represents no distress and 10 represents extreme distress. Further, patients are asked to choose from among 34 items that constitute sources of distress within the last week. All women who were undergoing their first chemotherapy treatment at the outpatient clinic at the University of Oklahoma Cancer Institute for either primary disease or recurrent disease were asked by the clinical nurses to complete the assessment prior to that first infusion. RESULTS: Over half (57%) of women reported a score of 4 or greater on the DT and were then assessed by the oncology psychologist. Women who were younger than age 60 and single were more likely to be distressed. There were no associations between the type of cancer, stage of cancer, or insurance status. CONCLUSIONS: A significant percentage (57%) of these women experienced distress at levels that indicate further evaluation is indicated. This study suggests that early screening and evaluation are essential in this group of cancer patients.