Implementation of Caregiver Distress Screening

Abstract

Introduction One area in which high levels of distress among cancer patients is consistently found is the SCT population, with over 50% of patients demonstrating clinically significant levels of distress. Research has also found that caregivers across cancer diseases endorse even higher levels of distress than patients, particularly in SCT population with higher or equal caregiver distress compared to patients’ pre-transplant. The emotional and physical health of the caregiver ineveitably impacts care for the patient, making the measuring and assessing of caregiver distress, particularly in the SCT population, necessary and critical. However, many barriers to caregiver distress screening have been identified in this population. Objectives Successfully and efficiently implement caregiver distress screening at this NCI accredited Cancer Center and assist others in learning challenges that may be encountered and how to address them. Methods Implementation of caregiver screening was met with several barriers including engaging key stakeholders, identifying time point for screening, legal medical concerns for documentation, and workflow of caring for patients and caregivers. Overarching all of these barriers is the utility of the electronic medical record system and its capabilities. Results The first barrier in this process was identifying the key stakeholders. A multi-disciplinary team was created which included physicians, psychologists, nurses, nursing leadership, program administrators, quality coordinator, and informatics specialists. With the multi-disciplinary team came buy-in and distribution of responsibilities in the adaptation of the workflow for caregiver screening. When defining the workflow, a standard screening opportunity presented itself at initial consult and survivorship appointment. Collaborating with internal policy makers, the team obtained approval for documentation of caregiver distress in patient chart with legal medical records. A workflow to have a phone triage for caregiver needs and scheduling was created to allow the caregiver a safe space to self-report desired referrals for self-care. The backdrop to all of these barriers was the limitations and strengths of our electronic medical records (EPIC). The informatics specialists cooperation in this project was a vital component in its implementation. Conclusion Currently the final electronic medical record system requests have been initiated and the plan for implementation is on-going. The project will be piloted in our Bone Marrow Transplant and Hematology ambulatory settings. The pilot will identify additional barriers and these will be addressed as needed. This implementation process will provide a comprehensive distress screening program at this NCI accredited Cancer Center, that also focuses on caregivers.