Implementing a nurse‐led screening clinic for symptom distress with community‐based referral for cancer survivors: A feasibility study

Author:

Lam Wendy Wing Tak12ORCID,Ng Danielle W. L.12ORCID,Fielding Richard12ORCID,Sin Vivian2,Tsang Catherine2,Chan Wendy W. L.3ORCID,Foo Chi Chung4ORCID,Kwong Ava4,Chan Karen K. L.5

Affiliation:

1. Centre for Psycho‐Oncology Research and Trainig, Division of Behavioural Sciences, School of Public Health LKS Faculty of Medicine The University of Hong Kong Hong Kong SAR China

2. LKS Faculty of Medicine Jockey Club Institute of Cancer Care The University of Hong Kong Hong Kong SAR China

3. Department of Clinical Oncology LKS Faculty of Medicine School of Clinical Medicine The University of Hong Kong Hong Kong SAR China

4. Department of Surgery LKS Faculty of Medicine School of Clinical Medicine The University of Hong Kong Hong Kong SAR China

5. Department of Obstetrics and Gynaecology LKS Faculty of Medicine School of Clinical Medicine The University of Hong Kong Hong Kong SAR China

Abstract

AbstractIntroductionThis prospective, single‐arm, pragmatic implementation study evaluated the feasibility of a nurse‐led symptom‐screening program embedded in routine oncology post‐treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community‐based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress.MethodsUsing the modified Edmonton Symptom Assessment System (ESAS‐r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate‐to‐severe symptom distress were referred to a nurse‐led community‐based symptom‐management program involving stepped‐care symptom/psychosocial management interventions using a pre‐defined triage system. Reassessments were conducted at 3‐months and 9‐months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS‐r score change over time.ResultsOverall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS‐r symptom as moderate‐to‐severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS‐r scores improved significantly over time (p < 0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3‐month post‐baseline, an additional 72(22%) recovered at 9‐month post‐baseline, while 43(12.2%) had resumed ESAS caseness at 9‐month post‐baseline.ConclusionNurse‐led SDS programs with well‐structured referral pathways to community‐based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

Publisher

Wiley

Subject

Psychiatry and Mental health,Oncology,Experimental and Cognitive Psychology

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