Feasibility of implementing the 'Screening for Distress and Referral Need' process in 23 Dutch hospitals.

PURPOSE: In the Netherlands, the three-step process 'Screening for Distress and Referral Need' (SDRN) was developed for helping identifying, and referring cancer patients suffering from clinically relevant distress or needing a referral. This process includes (1) instrument completion, (2) patient-care provider discussion of the responses, and (3) referral based on 1 and 2. The Netherlands Comprehensive Cancer Organisation, location Groningen (IKNL-G), initiated the implementation of SDRN and developed an implementation roadmap, including procedure and materials. This exploratory study examines the feasibility of SDRN implementation in hospitals, seen from healthcare providers' perspective, responsible for implementation, and those executing SDRN. METHODS: Healthcare providers, from 22 hospitals and from 5 oncology departments of the University Medical Center Groningen (=25 % of Dutch hospitals), evaluated their experiences by responding to a 26-item internet survey. RESULTS: Twenty-five participants (response = 93 %) completed the survey. SDRN was implemented in 21 hospitals (implementation = 91 %), in two thirds of these hospitals in more than one patient group. Adoption of IKNL-G's roadmap elements varied between 84 and 100 %. Participants' average satisfaction score with SDRN was 6.5 (possible range = 0-10, range found = 5-8). Significant positive relationships were found between this satisfaction and participants' satisfaction with frequency of SDRN (p = 0.02), and keeping logistical agreements (p = 0.04). Participants were dissatisfied with SDRN's limited current availability to only select patient groups and only certain disease phases. CONCLUSIONS: The implementation of SDRN in daily practice, supported by a pre-developed implementation roadmap, is highly feasible. Continuous attention to SDRN execution, broadening implementation to all forms of cancer, and during the total disease trajectory seems vital to improve healthcare providers' satisfaction.

Cancer patients' referral wish: effects of distress, problems, socio-demographic and illness-related variables and social support sufficiency.

BACKGROUND: The present study's aim was to examine effects of cancer patients' perceived distress and problems, socio-demographic and illness-related variables and social support sufficiency on referral wish. METHODS: A cross-sectional group of 1340 patients (response = 51%) completed a questionnaire consisting of the Dutch version of the Distress Thermometer and Problem List, including the referral wish question, and questions on socio-demographic and illness-related variables and perceived social support sufficiency. Univariate and multivariate analyses were performed to investigate the effects of these variables on patients' referral wish. RESULTS: Of the patients who completed the referral wish question (N = 1297), 13% wished and 21% considered a referral, while 66% did not want a referral. Univariate analyses showed that, in comparison with patients not having a referral wish, those having a (maybe) wish were more distressed, reporting more problems in all Problem List domains, younger, more likely not to have children or children living at home, higher educated, more likely to be employed, under active treatment or recently diagnosed, receiving more intensive treatment and more likely to perceive support received to be insufficient. A final ordinal logistic regression analysis showed independent effects of distress, practical and emotional problems, age and treatment phase on referral wish (χ2 (6) = 205.9; p < 0.001; Nagelkerke's R2 = 0.24). CONCLUSIONS: A third of the patients (maybe) wished a referral. Knowledge of risk variables (particularly increased distress, experience of more practical and emotional problems, younger age and receiving active treatment or recently diagnosed) may support the identification of patients at increased need of additional healthcare services. Copyright © 2016 John Wiley & Sons, Ltd.

Distress, problems and referral wish of cancer patients: differences according to relationship status and life phase.

OBJECTIVE: The aim of this study is to examine differences in distress, problems and referral wish in cancer patients according to relationship status and life phase. METHODS: A cross-sectional group of 1340 patients (response = 51%) completed socio-demographic and illness-related questions, and the Dutch version of the Distress Thermometer and Problem List that also assesses desire for additional care (yes, maybe and no). Relationship status was categorized into six groups (married, cohabiting, LAT (=living-apart-together: have a partner but live alone), divorced, widowed or single) and age into young (18-50), middle aged (51-65) and older (65+) cohorts. RESULTS: Relationship status and life phase were independently related to high distress, referral wish and accordance between the latter two. Single and LAT patients were around two times more likely than married patients to be highly distressed, and wanting additional care. The same was found for younger patients as compared to 65+ patients. Whereas high distress is usually not a strong indication for additional care needs, single, LAT and younger patients most often wanted care when they were highly distressed. CONCLUSION: Health care professionals who implement distress screening in practice can expect a higher need for additional care in single and LAT patients, but only when they are younger or middle aged. The benefit of having a partner around on a daily basis seems less important in dealing with cancer-related problems when patients are older.