Educational intervention in cancer outpatient clinics on routine screening for emotional distress: an observational study.

Objective: To examine the possible effect of an educational model on distress screening in newly diagnosed cancer patients referred to Psycho-oncology service (POS).

Methods: We examined the differences in distress and problems among newly diagnosed cancer patients referred to POS by cancer care professionals' according to their clinical judgement (2-year period; Study-1) and after an educational intervention on the Distress Thermometer (DT) and Problem List (PL), with referral to those reporting cut-off scores indicative of 'caseness' (DT>4) (1-year period; Study-2).

Results: In Study-1, 153 (6.7%) of 2268 new patients were referred and seen by the POS, which submitted each patient to the DT/PL. About one-third of the patients (31%) were not DT-cases (scores < 4) and showed lower levels of emotional and relational problems than those who resulted DT-cases. In Study-2, of all newly diagnosed cancer patients (n = 1107), 583 (52.6%) were administered to the DT/PL by nurses. Two-hundred and eighty-four (52.2%) resulting DT-cases were referred to POS and, of these, 133 (12% of all new patients; 22.81% of those screened; 46.8% of cases) were seen by the POS. There were significant differences in problems between not referred (DT-non-cases) and referred patients (DT-cases).

Conclusions: Because of the observational nature of the study, the conclusions should be drawn with caution. The implementation of the routine use of DT/PL seemed to determine a higher (79% increase) and more accurate referral of patients but the rate of acceptance was not high, confirming that more effort is necessary in implementing optimal psychosocial care in oncology.