Screening for Distress: Improving Patient Experience in Oncology Care

1. The Supportive Care Oncology Network Northeast Region: Moving Forward, Improving the Patient Experience Utilizing Screening for Distress Northern Health Research Conference Northern Ontario School of Medicine June 4 - 5, 2010 – Sudbury, Ontario Sheila Damore-Petingola, MSW, RSW Coordinator Supportive Care Oncology Network-NE Carole Mayer, Ph.D. (C), MSW, RSW Program Leader & Administrative Manager Supportive Care Program & Supportive Care Oncology Research Unit

2. Acknowledgements • Director of Epidemiology • Mike Conlon, PhD • Research Officers • Michelle Lessard • Katherine MacKenzie • Funding Partners • Canadian Partnership Against Cancer-Cancer Journey Action Group • Northern Cancer Research Foundation

3. Presentation Outline • Context • Supportive Care Oncology Network-NE • Community Oncology Clinic Network • Project Overview • Principals applied • Stakeholder engagement • Respecting cultural diversity • Participatory Action Research framework • Plan the delivery of psychosocial services • Implement an evaluation plan • Conclusion

4. Context • The Regional Cancer Program - tertiary cancer centre for cancer services in Northeastern Ontario • The Supportive Care Program - meeting the psychosocial needs of patients and families affected by cancer • The Supportive Care Oncology Network-Northeast Region (SCON-NE) – ensuring access to supportive care services in NEO • Screening for Distress Project

5. James Bay Community Oncology Clinic Network (COCN) NE Local Health Integration Network (LHIN-13) LHIN-13 Northwestern Ontario Quebec Kapuskasing Cochrane Timmins Kirkland Lake Chapleau New Liskeard Lake Superior Sudbury Sault Ste. Marie North Bay Elliot Lake Blind River Sturgeon Falls Mindemoya Parry Sound Lake Michigan Huntsville Lake Huron U.S.A. Bracebridge

6. Principles

7. Expanding Screening for Distress in NEO Educating health care professionals at the Community Oncology Clinic sites in NEO • Identifying patient distress • Quantifying the distress with validated instruments – screening • Responding to distress by initiating appropriate referrals for assessment and intervention

8. Distress as the 6th vital sign • Temperature • Respiration • Heart rate • Blood Pressure • Pain • Distress -Screening is usually done to prevent disease -Vital signs taken on ongoing basis Screening for Distress Workshop March 2008

9. Screening Domains ESAS Physical Psychosocial Severityof Scores Score 7-10 Practical Score 4-6 Score 0-3 CPAC-Implementing Screening for Distress, the 6th Vital Sign, 2009

11. Problem Checklist (minimal data set) Please check all of the following items that have been a concern or problem for you in the past week including today: CPAC-Implementing Screening for Distress, the 6th Vital Sign, 2009

12. What is proposed for this project • Who to Screen: All patients receiving chemotherapy at a COCN site (14 sites) • When to Screen: First day for each cycle of chemotherapy • How to Screen: Using computerized method when possible; other option paper copy • Screening domains: Psychosocial, practical and physical • Tool selection: ESAS and Canadian Problem Checklist

13. Stakeholder Engagement • Support from senior administrators from the Regional Cancer Program (RCP) • Building on current mandate within the RCP and Cancer Care Ontario (CCO) • Meeting the Canadian Council on Health Services Accreditation standards • Workshop held in May 2009 with National Leaders for COCN site managers and nurses • Engaging each COCN site through site visits • Selecting champions • Building a Working Committee

14. Respecting Cultural Diversity • Demographic and Health Profile for NE - LHIN • Higher proportion of Aboriginals/First Nations/Métis than Ontario as a whole, 10% and 2% respectively • Higher proportion of Francophones compared to Ontario as a whole, 24% and 4% respectively (Population Profile at a Glance – NE LHIN http://www.nelhin.on.ca) • Working Committee representation • Demographic questionnaire for each patient being screened • All forms available in English and French

15. Participatory Action Research (PAR) • Equalizing power imbalances in the project—seeking participants’ input • Research process involves taking notice of the findings at different stages of the research which informs actions to be taken throughout the process (Nelson et al., 1998)

16. Plan the Delivery of Psychosocial Oncology Services at 14 COCN Sites • Identification of resources within communities • Community hospitals • Community Care Access Centre • Building a safety net • Use of telemedicine • Provision of education and discussion forums • Eg. May 14/2010 workshop • Next step • Developing referral pathways

17. EvaluationSupportive Care Oncology Research Unit • Demographic form • ESAS Scores • Canadian Problem Checklist • Nursing outcome form • Completion of project March 31, 2011

18. Current Status of the Project • Workshop – Introduce the Project - May 2009 • COCN Site Visits • Sept-Oct 2009 • Jan-May 2010 • Monthly Working Committee meetings • Initial meeting Oct 2009 • Workshop – May 2010 - to advance understanding of: • supportive care resources in NEO • national algorithms and guidelines in addressing distress • All 14 COCN sites implemented screening • Nov 16, 2009 – June 1, 2010

19. Conclusion • Implementing a standard of care to meet the psychosocial needs of cancer patients receiving treatment closer to home • Learning from our COCN sites • Team work, team work, team work!

20. For more information sdamore-petingola@hrsrh.on.ca