Objective
Distress in cancer patients leads to poorer outcomes. Much emphasis has been placed on routine distress screening, yet little is known about the resulting referrals from screening. This project aimed to examine referrals made as a result of routine distress screening to provide insight into how screening is operationalised in practice to support patient distress management.
Methods
Screening was conducted with the NCCN distress thermometer/problem list with additional custom items. All outpatient medical oncology supportive care screening at Monash Health from 1 December 2023 to 31 May 2024 was extracted from medical records. Extracted data included distress levels, problem list endorsements, support perceptions, referrals made as a result of screening, and demographics. For those declining screening, patient and cancer characteristics were recorded.
Results
851 supportive care screenings were offered to 644 individual patients (55% female; aged 24y–93y, Mage = 61.3y, SD = 12.5y). 88 (13.7%) patients declined screening, leaving 763 complete supportive care screenings. Of those who accepted screening, 55.3% reported clinically significant distress (DT score ≥ 4). 60.1% endorsed at least one emotional concern from the problem list. Across completed screenings, 63.7% (n = 486) resulted in no referral and 36.3% (n = 277) resulted in at least one referral. The most common referrals after screening were to the Cancer Council support line (n = 163, 41.3% of all referrals), dietitians (n = 72, 18.2%), social workers (n = 40, 10.1%), cancer support nurses (n = 22, 5.6%), and psycho-oncology (n = 5, 1.3%).
Conclusions
In outpatient oncology, most patients report elevated distress and emotional concerns. Most referrals are to the Cancer Council support line, with few to in house services or those focused on mental health/emotional concerns. Refinement of hospital resourcing is needed to support patient needs and ensure staff and patient time spent on screening drives action.