Improving distress screening in radiation oncology consultation.

Abstract

332 Background: Receiving a cancer diagnosis and awaiting initial management recommendations is a stressful time. Distress should be recognized, documented, and treated promptly as part of quality oncologic care. The NCCN Distress Thermometer (DT) is a useful tool for patients to quantify their level of distress. This pilot study assesses the rate of distress screening at a high-volume academic healthcare network, before and after institutional quality improvement (QI) intervention. Methods: All patients seen for Radiation Medicine between 1/1/22 - 12/31/23 were reviewed. Rates of DT documentation at the time of consultation were assessed as the QI metric. Patients seen in 2022 served as a baseline of departmental compliance. The importance of distress assessment was formally introduced to physicians and advanced care practitioners (ACPs) in Q4 2022 during monthly departmental quality reports, with notice that a formal QI metric would be monitored beginning 1/1/23. Chi-square test was used to compare rates of DT documentation. Monthly departmental DT documentation rates were back presented to the physicians and ACPs during quality meetings. Results: 9391 patients were seen for radiation oncology consultation (2022 = 4311; 2023 = 5080). Baseline DT documentation was 51.0%. Initial compliance with the metric was below baseline, at 41.4% for Jan 2023. With continued feedback, education, and goal-setting, rates of DT use continually improved over Q1/Q2 2023 and remained relatively steady through the remainder of Q3/Q4 2023, reaching a monthly high of 89.8%. Overall DT documentation significantly improved for 2023 was 81.4% (χ 2 = 977.9, p < 0.0001). The rates of DT documentation were relatively consistent based on diagnoses codes, though lower amongst consults seen for metastatic disease (84.0% vs 73.4%, χ 2 = 24.28, p < 0.0001). Conclusions: Screening rates at consultation are modifiable and maintainable, but distress management remains a continuous quality improvement project as we explore services to address identified stressors and reassess distress levels at future visits.