Development and implementation of a comprehensive psychosocial screening program in a Brazilian cancer center.

Abstract

International guidelines recommend routine screening for distress as part of care practices. Accordingly, a Brazilian cancer center developed and implemented a distress screening program (DS) in 2007, which was enhanced in 2009 through the inclusion of a psychosocial care meeting group (DS+PCM) regarding patients' psychosocial needs. The current paper will provide an overview of the development and pilot implementation of this program and initial analyses to assess patient outcomes and report initial results to extend international research on this key aspect of cancer care. Patients were assessed for distress, anxiety and depression, and in the DS+PCM phase for quality of life at the first day of chemotherapy infusion, at midpoint, and at treatment end. We compared data from program phases (DS vs DS+PCM), with a sequential cohort design and mixed effects modeling. Clinical and demographic characteristics were similar between groups. Patients receiving DS+PCM showed significantly lower distress and depression/anxiety upon chemotherapy initiation (Ps<.001). While both groups reported significantly lowered distress and total depression/anxiety scores across time (Ps<.003), patients receiving DS+PCM maintained the lowest distress and total anxiety/depression at all assessments. Patients from DS+PCM group also reported improvements in quality of life over time. The current study provides preliminary evidence that a multidisciplinary structured screening program utilizing validated measures and team meetings is associated with reduced impairment in patients' psychological well being. This program provided more opportunities for collaboration among providers with increased multidisciplinary meetings, enabled patients to more easily report problems, and ensured rapid access to relevant resources.