Implementation of the Edmonton Symptom Assessment System for Symptom Distress Screening at a Community Cancer Center: A Pilot Program.

BACKGROUND: Distress screening is mandated by the American College of Surgeons Commission on Cancer; however, there is limited literature on its impact in actual practice. We examined the impact of a pilot distress screening program on access to psychosocial care. METHODS: Edmonton Symptom Assessment System (ESAS) screening was routinely conducted at our community-based medical oncology program. Patients who screened positive for severe distress were sent to a social worker for triage and referred to the appropriate services if indicated. We compared the proportion of patients who had ESAS completed, the proportion of patients who screened positive, and the number of patients who had social work assessment and palliative care consultation over the preimplementation (September 2015), training (October/November 2015), and postimplementation (December 2015) periods. RESULTS: A total of 379, 328, and 465 cancer patients were included in the preimplementation, training, and postimplementation periods, respectively. The proportion of patients who completed ESAS increased over time (83% vs. 91% vs. 96%). Among the patients who had completed ESAS, between 11% and 13% were positive for severe distress, which remained stable over the three periods. We observed a significant increase in social work referrals for psychosocial assessment (21% vs. 71% vs. 79%). There was also a trend towards an increased number of palliative care referrals (12% vs. 20% vs. 28%). CONCLUSION: Our community-based cancer center implemented distress screening rapidly in a resource-limited setting, with a notable increase in symptom documentation and psychosocial referral. IMPLICATIONS FOR PRACTICE: The American College of Surgeons Commission on Cancer mandates distress screening; however, there is limited literature on how this process should be implemented and its impact on clinical practice. We used the Edmonton Symptom Assessment System for routine symptom distress screening in a community-based medical oncology program that provides care for an underserved population. Comparing before and after program implementation, we found an increase in the number of documentations of symptom burden and an increase in psychosocial referrals. Findings from this study may inform the implementation of routine symptom distress screening in cancer patients.

What currently defines a breast center? Initial data from the national accreditation program for breast centers.

PURPOSE: The definition of a "breast center" varies significantly, ranging from hospital-based or free-standing comprehensive programs to private subspecialty practices with patient resources in close proximity. This study analyzes the 2-year data of the National Accreditation Program for Breast Centers (NAPBC) to assess the demographics of the types of programs seeking breast center (BC) accreditation. The results of a postaccreditation survey are also analyzed. MATERIALS AND METHODS: All data (ie, Survey Application Record, on-site surveyors' reports, postaccreditation survey) for programs applying for accreditation between October 31, 2008, and October 31, 2010, were entered into a database at the American College of Surgeons headquarters. Analysis was conducted with SPSS v.19 and Microsoft Excel 2007. RESULTS: During the initial 2-year period, 238 centers were surveyed across 41 states. With regard to the 27 standards and 17 BC components, 68% of centers had no deficiencies, 28% had ≤ 10% deficiencies, 3% had deficiencies in 11% to 29% of standards, and 2% had ≥ 30% deficiencies. The most common standards with noncompliance were accreditation for ultrasound-guided biopsy (standard 11), stereotactic biopsy (standard 10), and accrual onto clinical trials (standard 3.2). The only BC component found to be absent was survivorship program (1%). Desciptive categories were as follows: 81.5% were hospital-based centers, 13.5% were free-standing facilities, 2.5% were group practices, and 3% were "other." There were no significant associations between descriptive category and full accreditation versus contingency or failure, or deficiencies in any one standard (all Ps > .05). On the basis of responses to the postaccreditation survey, 76% admitted making significant changes before the survey process. CONCLUSION: This initial analysis of the NAPBC 2-year data suggests that a wide variety of BC models adequately provide a high level of care and services for patients across the nation.