Assessment Of Emotional Well-being Research Articles

The Value of New Fields in the Medical Record for Quality Improvement.

Quality in healthcare delivery is important for the safety and experience of patients with cancer. Effective documentation is an integral component of quality improvment, and accurate documentation can be affected by prompts in the medical record, potentially improving quality of services. The Contemporary Oncology Team (COT) is a Greek private oncology practice that participated in the American Society of Clinical Oncology's (ASCO's) Quality in Oncology Practice Initiative (QOPI). Between 2014 and 2019, COT implemented changes in its paper patient medical record, in order to improve quality of care and documentation. Fields regarding pain, emotional well-being and psychosocial assessment, discussions with the patient and consent about treatment and disease, medication details and cumulative dose, treatment goals, side-effect grading, pregnancy screening, treatment adherence and anticipated duration were added. In this report, we present the association of these improvements with COT performance in QOPI. Pain and emotional well-being assessment and documentation were significantly improved by the development of a structured patient follow-up form. In contrast, the assessment of fertility issues, tobacco use, and the documentation of treatment plan and intent did not present a drastic change, because COT performance was already above QOPI average. A thorough reform of COT paper medical record according to QOPI standards improved QOPI scores, but more importantly effected a shift in the team's culture to safer and more standardized quality based care.

Emotional Wellbeing Assessment for Elderly Using Multi-Language Robot Interface

There is always necessity prevailing for the exposed platforms under the vigilance of experts, incorporated with the capability of developing and gathering enquiries followed up by the analysis and remedial measures based on the long duration laborious medical follow-up. So the work carried out in the paper initiates to cultivate a robotic interface with the multi-language capability to assist in monitoring and assessing the emotional health of the elderly people by extending conversations. For this purpose the proposed method utilizes the voice interface to put forward, enquires from the experts and the robotic interface developed converses automatically to the clients with the supervisions of the experts to course the replies. The proposed system would be compatible in any room as it is carried out on an embedded platform designed for the edge computing. The advantage of the system was understood by subjecting it to the answer files in the audio form and validating it in the terms of the recognition scores, and the percentage of estimation accuracy.

‘Baby Coming – You Ready?’ An audacious innovation to perinatal social and emotional wellbeing assessment screening and supportive management for vulnerable parents-to-be

This study explored the risk of antenatal psychosocial distress (APD) and associated potential factors and examined management aspects of risk of APD in women attending Aboriginal primary health care services in Australia.Audits of medical records of 797 pregnant women from 36 primary health centres in five jurisdictions (NSW, QLD, SA, WA and NT) were undertaken as part of a quality improvement programme. Information collected included mental health assessed by a standard screening tools, enquiry regarding social and emotional well-being (SEWB), depression management (including antidepressant medications) and referral.Around 18% (n= 141) of women were at risk of APD based on assessment using a standard screening tool or by SEWB enquiry. There was a significant association between risk of distress and women’s life style behaviours (e.g., alcohol, illicit drug use) and health centre characteristics. Of the 141 women, 16% (n= 22) were prescribed antidepressant drugs during pregnancy. A range of nonpharmaceutical mental health interventions were also recorded, including brief intervention of 61% (n= 86), counselling of 57% (n= 80) and cognitive behaviour therapy of 5% (n= 7). About 39% (n= 55) of women with APD were referred to external services for consultations with a psychiatrist, psychologist or social worker or to a women’s refuge centre.The higher risk of APD associated with women’s life style behaviour indicates that the better understanding of mental health in its cultural context is essential.

Gender differences confirmed in cardiac surgery patients in cardiac rehabilitation

The leading cause of death in Europe is cardiovascular diseases (CVD), it causes 4 million deaths a year. Lithuania is classified as a high risk group of CVD. Many studies have shown that there are gender related differences in the way cardiac symptoms and diseases are perceived the incidence and course of coronary disease, cardiac treatments, and cardiac surgery. One hundred and twenty-five patients after cardiac surgery: valve surgery 37.8% ( n = 48), coronary artery bypass graft surgery (CABG) 52.8% ( n = 67), combined 9.4% ( n = 10) undergoing exercise training inpatient CR were studied in order to evaluate the effect of a CR programme on the quality of life. Functional capacity was assessed by a 6 minutes walking test and quality of life was assess by using the Short-Form (36) General Health Survey (assess patient's health and emotional well-being) scale from 1 to 100, on admission and at the end of 3 weeks programme. In the study participated 89 men (71.2%) and 36 women (28.8%). Men average age was 62.53 ± 1.85; women - 67.78 ± 1.6 ( P = 0.017). The prevalence of risk factors was not statistically significantly different between men and women ( P > 0.05). The physical capacity according to 6MWT was statistically significantly lower in women before and after CR (before 341.2 ± 24.1 vs. 246.2 ± 21.2 m., P = 0,004 after 417,1 ±13.29 vs. 341.2 ± 24.1, P = 0.009). Results of SF-36 general health assessment (45.9 ± 1.9% vs. 47.41 ± 3.5%) and emotional well-being (59.17 ± 2.81% vs. 62.4 ± 2.9%) at the beginning of CR did not differ (> 0.05). After CR women rated their general health (45.72 ± 2.36% vs. 54.4 ± 2.77%, P = 0.037) and emotional well-being (82.35 ± 2.65% vs. 71.2 ± 2.57%, P = 0.012) statistically significantly higher. In the female group, general health and emotional well-being assessment after CR were better evaluated, although women were older and their physical capacity was lower.

Improving well-being in patients with major neurodegenerative disorders: differential efficacy of brief social robot-based intervention for 3 neuropsychiatric profiles

BackgroundBehavioral and psychological symptoms of dementia (BPSD) affect patients’ daily life and subjective well-being. International recommendations stress nonpharmacological interventions as first-line treatment. While newer psychosocial initiatives adapted to geriatric populations based on social robot therapy have emerged, to our knowledge, no studies on differential efficacy depending on BPSD profiles have been conducted yet.ObjectivesThis pilot study examined the impact of short exposure to a social robot (Paro®) on the subjective emotional well-being of patients with major neurocognitive disorder as well as its impact on differential effects for 3 BPSD profiles.MethodsSeventeen patients with major NCD with apathy (n=6), depression (n=7), and agitation (n=4) were recruited. The intervention was composed of four 15-minute individual sessions. Exposure occurred without the simultaneous presence of a health care provider. A pre–post assessment of emotional well-being was conducted with the International Positive and Negative Affect Schedule Short-Form, which measures positive and negative affectivity.ResultsOverall findings showed a significant increase of positive affectivity (p=0.02). Subgroup analysis demonstrated that agitated patients reduced negative affectivity significantly more than depressed patients (p=0.03). Results also confirmed users’ overall acceptability of the robot.ConclusionThese findings support the usefulness of brief interactive sessions with the Paro robot for elderly patients with major NCD. These preliminary results encourage further research focused on brief interventions using social robotics, as well as on their specific benefits depending on the behavioral typology of patients with neurocognitive disorders.

Factors Associated with Maternal Wellbeing at Four Months Post-Partum in Ireland.

This study aimed to examine factors associated with maternal wellbeing at four months post-partum in the Irish context. Socio-demographic, health behaviour and infant feeding data were collected in pregnancy, at birth and at 17 weeks post-partum. Maternal distress, body image and resilience were measured at 17 weeks post-partum. Binary logistic regression predicted maternal distress and statistical significance was taken at p < 0.05. One hundred and seventy-two women were followed-up in pregnancy, at birth and at 17 weeks post-partum. Three in five (61.6%, n106) initiated breastfeeding. At 17 weeks post-partum, 23.8% (n41) were exclusively or partially breastfeeding and over a third (36.0%, n62) of all mothers were at risk of distress. In multivariate analyses, independent predictors of distress included: low maternal resilience (p < 0.01, odds ratio (OR): 7.22 (95% confidence interval [CI]: 2.49–20.95)); unsatisfactory partner support (p = 0.02, OR: 3.89 (95% CI: 1.20–12.65)); older age (p = 0.02, OR: 1.11 (95% CI: 1.02–1.21)); and breastfeeding (p = 0.01, OR: 2.89 (95% CI: 1.29–6.47)). Routine assessment of emotional wellbeing and targeted interventions are needed to promote a more healthful transition to motherhood among women in Ireland.

Art museum-based intervention to promote emotional well-being and improve quality of life in people with dementia: The ARTEMIS project.

ARTEMIS (ART Encounters: Museum Intervention Study) is an art-based intervention designed especially for people with dementia and their care partners that involves a combination of museum visits and artistic activity. This paper reports the results of a randomized wait-list controlled study on the influence of the ARTEMIS intervention on the emotional state, well-being, and quality of life of dementia patients. People with mild-to-moderate dementia (n = 44) and their care partners (n = 44) visited the Frankfurt Städel Museum once a week on six pre-arranged occasions. The intervention consisted of six different guided art tours (60 minutes), followed by art-making in the studio (60 minutes). Independent museum visits served as a control condition. A mixed-methods design was used to assess several outcomes including cognitive status, emotional well-being, self-rated aspects of quality of life, and subjective evaluations by informal caregivers. In a pre-post-assessment, we found significant improvements in participants' self-rated quality of life (t = -3.15, p < .05). In a situational assessment of emotional well-being immediately before and after each of the museum sessions, we were able to demonstrate statistically significant positive changes with medium effect sizes (dcorr = .74-.77). Furthermore, the total Neuropsychiatric Inventory score as well as the affective (depressed mood and anxiety) and apathy subscales were significantly lower after the ARTEMIS intervention (tNPI total = 2.43; tNPI affective = 2.24; tNPI apathy = 2.52; p < .05). The results show that art museum-based art interventions are able to improve the subjective well-being, mood, and quality of life in people with dementia. This promising psychosocial approach deserves further attention in future studies and consideration in community-based dementia care programs.

CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers.

CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

Factors influencing maternal distress among Dutch women with a healthy pregnancy.

Maternal distress is a public health concern. Assessment of emotional wellbeing is not integrated in Dutch antenatal care. Midwives need to understand the influencing factors in order to identify women who are more vulnerable to experience maternal distress. To examine levels of maternal distress during pregnancy and to determine the relationship between maternal distress and aetiological factors. A cross-sectional study including 458 Dutch-speaking women with uncomplicated pregnancies during all trimesters of pregnancy. Data were collected with questionnaires between 10 September and 6 November 2012. Demographic characteristics and personal details were obtained. Maternal distress was measured with the Edinburgh Depression Scale (EDS), State-Trait Anxiety Inventory (STAI), and Pregnancy-Related Anxiety Questionnaire (PRAQ). Behaviour was measured with Coping Operations Preference Enquiry-Easy (COPE-Easy). Descriptive statistics and multiple linear regression analysis were used. Just over 20 percent of the women in our sample (21.8%) had a heightened score on one or more of the EDS, STAI or PRAQ. History of psychological problems (B=1.071; p=.001), having young children (B=2.998; p=.001), daily stressors (B=1.304; p=<.001), avoidant coping (B=1.047, p=<.001), somatisation (B=.484; p=.004), and negative feelings towards the forthcoming birth (B=.636; p=<.001) showed a significant positive relationship with maternal distress. Self-disclosure (B=-.863; p=.004) and acceptance of the situation (B=-.542; p=.008) showed a significant negative relationship with maternal distress. Maternal distress occurs among women with a healthy pregnancy and is significantly influenced by a variety of factors. Midwives need to recognise the factors that make women more vulnerable to develop and experience maternal distress in order to give adequate advice about how to best cope with this condition.

Florida Initiative for Quality Cancer Care: Changes in Psychosocial Quality of Care Indicators Over a 3-Year Interval.

Identifying and addressing psychosocial concerns is increasingly recognized as an important aspect of cancer care that needs to be improved. As part of the Florida Initiative for Quality Cancer Care, medical record reviews were conducted to evaluate cancer care, including psychosocial care, at oncology practices in Florida in 2006. Results were subsequently disseminated to the practices, and performance was reassessed at the same practices in 2009. Data were available for patients with colorectal, breast, and non-small-cell lung cancer first seen by a medical oncologist in 2006 (n = 1,609) and 2009 (n = 1,720) at the same 10 practice sites. Performance on each psychosocial indicator was evaluated for overall change over time and for variability in change based on practice site and cancer type. The percentage of patients identified as having a problem in emotional well-being increased significantly over time, from 24% to 31% among those assessed (P = .002) and from 13% to 16% overall (P = .026). In contrast, there no significant changes over time in assessment of emotional well-being (53% to 51%, P = .661) or in action taken to address problems (57% to 45%, P = .098). Findings suggest more intensive efforts than audit and feedback will be required to improve the quality of psychosocial care and that greater recognition of problems with emotional well-being may tax the ability of practices to link patients with appropriate services. Systematic research is needed to identify and disseminate effective strategies for implementing routine assessment of well-being and addressing the increased demands for care this will generate.

Assessing and acting on distress in oncology patients.

89 Background: The American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) set a benchmark that 75% of cancer patients have emotional well-being assessed by the second visit. However, clinicians poorly assess and document emotional well-being. Methods: Our aim was to increase the documented assessment of emotional well-being in an academic medical center's Hematology/Oncology clinic to 75% or greater through a pre/post intervention study design. In fall 2012, clinicians collected baseline QOPI data from the first two visits of a sample of patients with newly diagnosed breast, non-small cell lung and colorectal cancers. Oncology social work and psychiatry implemented the NCCN Distress Thermometer in May 2013. At every provider visit, patients' distress scores were transcribed into a structured field in the electronic record. In spring 2014, clinicians collected post-intervention data. Results: All data used was collected through the routine QOPI chart abstraction process. 142 charts in fall 2012, and 55 charts in spring 2014 met criteria for pre/post assessment, respectively. There was a significant improvement in the assessment of distress (78.2% vs. 64.1%, p=0.01) and in the identification of distress presence (46.5% vs. 27.5%, p=0.01). However, there was better documentation for a plan of action for distress before the intervention (80% vs. 55%, p=0.02). Conclusions: The NCCN Distress Thermometer improved assessment and identification of distress. However, an action plan specifically addressing distress was significantly worse after implementation of the tool. Possible explanations include lack of documentation even if an action was implemented, lack of specificity of the tool to identify the source of the patient's distress so that a therapeutic plan could be targeted, or a failure of the clinician to appreciate the distress score as a valid measure. Further data are needed in order to understand the barriers for clinician documentation of action on patient distress. [Table: see text]

Driving performance improvement using ASCO’s Quality Oncology Practice Initiative (QOPI).

203 Background: Defining and quantifying quality care is a challenge for cancer care providers. Since 2007 St. Luke’s Mountain States Tumor Institute (MSTI) has been participating in QOPI and was one of 23 practices that received the inaugural QOPI Certification in June 2010. The goal of participation is to benchmark MSTI’s performance with oncology practices across the nation and identify areas for improvement that are recognized as national quality standards. Methods: After each round of QOPI data abstraction, physician and administrative leadership selected measures with the greatest opportunity for improvement. Monthly chart audits for each measure were completed and the results were shared with individual staff to increase education and accountability. In Spring 2010, the education assessment in MSTI’s Electronic Medical Record (EMR) was redesigned to facilitate efficient documentation and data collection of smoking cessation counseling. In July 2011, the performance improvement (PI) team created “Quality Checklists (QCL)” in MSTI’s EMR for three different QOPI measures: i) signed chemotherapy consent, ii) smoking cessation counseling, and iii) assessment of emotional well-being. To ensure signed chemotherapy consent, one QCL included a reminder sent by the primary nurse or secretary to the chemotherapy infusion nurses. To ensure smoking cessation counseling and assessment of emotional well-being by social work, the other QCL included an alert sent by the new patient representative to the primary nurse and social worker. Results: Signed chemotherapy consent improved from 10% (n=229) in 2007 to 100% (n=117) in 2012. Smoking cessation counseling improved from 13% (n=40) in 2007 to 93% (n=272) in 2012. Assessment of emotional well-being improved from 78% (n=302) in 2007 to 95% (n=120) in 2012. Of the patients that had problems with emotional well-being, 73% (n=55) in 2007 had their problems addressed and 95% (n=41) in 2012. Conclusions: QOPI has provided MSTI with the initiatives and benchmarks to quantify quality cancer care. By combining participation in QOPI and ongoing PI data collection, analysis, and action plan implementation MSTI has enjoyed marked improvements in quality.

Toward proven and prioritized quality measures: Which ASCO QOPI and other supportive care measures associate with improved quality of life (QOL)?

165 Background: An expanding array of quality measures, including the Quality Oncology Practice Initiative (QOPI) metrics, is being developed for oncology. To date, evidence demonstrating the impact of each metric on outcomes, ultimately aiding in prioritization of individual measures, remains immature. We investigated the relationship between conformance with quality measures and higher patient QOL among cancer patients receiving palliative care. Methods: A comprehensive systematic review of PUBMED and the gray literature (1995-2012) identifed all described supportive care quality measures. Patients receiving palliative care in 4 community-based programs were entered into a longitudinal quality registry; analyses focused on cancer patients registered between 6/08-10/11. To find predictors of higher QOL, conformance cohorts were examined for demographic variables, performance status (measured by palliative performance scale, PPS) and provider estimation of prognosis and included in univariate and multivariate regression. Results: The systematic review yielded 303 quality measures. Of these, 18 measures, representing components of the ASCO QOPI, Hospice PEACE, and Cancer-ASSIST measure sets, were evaluable using registry data. 460 cancer patients were included. 60% of patients had weeks to 6 months expected prognosis. Among QOPI measures, conformance with two measures was significantly associated with better QOL: constipation assessment at time of narcotic prescription and emotional well-being assessment (both p&lt;0.05). Other significant findings were conformance with screening of symptoms at first visit (p=0.017), timely treatment for uncontrolled dyspnea (p=0.005), and assessment of fatigue (p=0.007). In a multivariate model predicting higher QOL, measures involving emotional well-being assessment (OR 1.60; p=0.026) and screening of symptoms (OR 1.74, p=0.008) remained significant. Conclusions: Clinical care that conforms to quality measures reflecting regular symptom and emotional assessment is significantly associated with better patient experiences (QOL) and should be prioritized in quality assessment efforts.

Capturing and addressing emotional well-being: Utilization of ASCO’s Quality Oncology Practice Initiative (QOPI) for performance improvement.

207 Background: Palmetto Hematology Oncology (PHO) is the medical oncology practice of Spartanburg Regional Healthcare System (SRHS) and has participated in QOPI since 2009 and earned QOPI certification in September 2011. Emotional well-being assessments and documentation of interventions were selected for a performance improvement project based on QOPI measures from Fall 2009. Methods: Several articles were identified supporting the use of the NCCN Distress Thermometer following a comprehensive literature search and approval was obtained for use. The NCCN Distress Thermometer was administered to all new patients through inclusion in “new patient” paperwork packets. Two physician offices within the practice were piloted with the physicians reviewing the patient reported assessments and documenting any required interventions. All completed NCCN Distress Thermometer forms were also reviewed by the medical social work team, and for scores &gt; 3, interventions by phone or face-to-face were completed by them and documented in the patients’ electronic medical records. Results: Due to the success of the pilot efforts the assessment/intervention process for emotional well-being was expanded throughout the PHO practice, the Gibbs Infusion Center, and Radiation Oncology. The QOPI emotional well-being indicator revealed an increase from the Fall 2009 to Spring 2012 of 36.25% to 96.25%. Conversely, our compliance with intervention by the second office visit decreased from 94.44% to 69.44%, respectively. Conclusions: Although PHO’s scores for the emotional well-being assessment have dramatically improved with implementation of the process improvement initiative, opportunity remains for improving emotional well-being intervention documentation. This initiative highlighted the lack of psychiatric/psychological services available to PHO patients.

Association of screening for psychosocial distress in patients with newly diagnosed stage IV NSCLC and survival.

9030 Background: While screening for psychosocial distress has become an ASCO QOPI indicator of quality cancer care, data has yet to show an association with improved cancer outcomes. We examined the relationship between adherence to the QOPI measure for assessment of emotional well-being and survival in a sample of patients with newly diagnosed stage IV NSCLC. Methods: From 8/07 to 9/10, we recruited consecutive new patients in a multidisciplinary thoracic oncology clinic to participate in a research database for which patients completed self-report instruments for depression (PHQ-9) and anxiety (GAD-7) at their first oncology visit. We then performed a QOPI chart audit for patients with stage IV NSCLC who received care at our institution. To adhere to the QOPI measure, oncologists were required to document their own assessment of patient emotional well-being (without access to patient self-report data) within one month of the first office visit. Survival was calculated from first oncology visit to death. Cox proportional hazards models were used to test associations with survival. Results: 243 patients completed baseline assessments and had follow up. Emotional well-being was assessed in 90 (37%). Median survival of those with an emotional assessment was 12 months vs. 10 months for those without (p=.03). Yet, emotional assessment was associated with younger age (p=.01) and higher depression (p=.05) and anxiety scores (p=.03). Controlling for age, sex, performance status, smoking, primary oncology provider, PHQ-9, and GAD-7, having an assessment of emotional well-being was associated with improved survival (HR .68, 95% CI .49-.93, p=.02). Although higher PHQ-9 scores were independently associated with worse survival (HR 1.05, 95% CI 1.02-1.08, p=.004), neither depression nor anxiety moderated the relationship between clinician screening and survival. Conclusions: In this large prospective study of patients with newly diagnosed stage IV NSCLC, adherence to the QOPI measure for assessment of emotional well-being was associated with a survival benefit. This benefit appears to extend to all patients, not just those with depression and anxiety. Randomized trials are needed to confirm these findings.

Commentary on an article by M.D. Daubs, MD, et al.: “Clinical Impression Versus Standardized Questionnaire: The Spinal Surgeonʼs Ability to Assess Psychological Distress”

The authors of this interesting study should be congratulated on a well-designed and executed clinical study that raises questions regarding the assessment of emotional well-being in patients with spinal disorders. This study attempted to determine whether spinal surgeons and other nonoperative spine specialists were able to accurately assess psychological distress in patients with spinal problems. The authors asked 400 new patients who presented with spinal disorders to complete the Distress and Risk Assessment Method (DRAM) psychological distress questionnaire and then determined in a blinded fashion how accurate eight physicians were in assessing the patients’ level of distress. In general, the physicians were better able to identify patients who had a relatively normal level of stress, but their ability to identify patients who were classified as having a high level of psychological distress was poor. Spinal surgeons seemingly were worse than the nonoperative physicians in their ability to identify patients in distress. The authors advocate that all spinal surgeons and specialists should utilize the DRAM to better identify patients in psychological distress in order to improve the clinical outcomes of those patients. On …

Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indicators

An American Psychosocial Oncology Society workgroup has developed indicators of the quality of psychosocial care that can be measured through review of medical records. The present report describes the first large-scale use of these indicators to evaluate psychosocial care in outpatient medical oncology settings. Medical records of 1660 colorectal, breast and non-small cell cancer patients first seen by a medical oncologist in 2006 at 11 practice sites in Florida were reviewed for performance on indicators of the quality of psychosocial care. Assessment of emotional well-being was significantly less likely to be documented than assessment of pain (52 vs 87%, p<0.001). A problem with emotional well-being was documented in 13% of records and evidence of action taken was documented in 58% of these records. Ten of eleven practice sites performed below an 85% threshold on each indicator of psychosocial care. Variability in assessment of emotional-well being was associated (p<0.02) with practice site and patient gender and age while variability in assessment of pain was associated (p<0.001) with practice site and cancer type. Findings illustrate how use of the psychosocial care indicators permits identification of specific practice sites and processes of care that should be targeted for quality improvement efforts. Additionally, findings demonstrate the extent to which routine assessment of emotional well-being lags behind routine assessment of pain in cancer patients.

Changes over time in quality of psychosocial care: Results from the Quality Oncology Practice Initiative (QOPI).

6000 Background: In 2008, ASCO's QOPI added quality measures for psychosocial care to the core set of measures completed by all participating practices. As part of a summary report based on data submitted from medical records, each practice is provided the percentage of its patients and the percentage of all patients audited for whom: 1) current emotional well-being was assessed within one month of the first visit with a medical oncologist; 2) action was taken if a problem with emotional well-being was identified. We sought to determine if performance on these indicators improved between Fall 2008 (when these indicators became part of the core) and Fall 2009 among practices that participated in both rounds of audits. Methods: 166 practices participated in both rounds and provided data on 30,853 patients. The average number of patients per practice was 90 in 2008 and 95 in 2009. Results: Average rates per practice for performing an assessment of emotional well-being improved over time from 64% to 73% (p < 0.001). This change was associated with an increase from 13% to 17% in the percentage of each practice's patients who were identified as having a problem with emotional well-being (p < 0.001). Average rates per practice for taking action if a problem with emotional well-being was identified increased minimally from 74% to 76% (p = 0.41). However, reflecting the higher percentage of patients being assessed, the percentage of each practice's patients for whom action was taken for a problem with emotional well-being increased from 9% to 13% (p < 0.001). Conclusions: Findings suggest that providing feedback to practices produced a marked increase in assessment of emotional well- being. As would be expected, this increase corresponded with more patients being identified as having problems with emotional well-being and more actions being taken to address problems with emotional well-being. Although an increase on this process indicator of quality care is encouraging, additional research incorporating outcome measures is needed to determine if conducting more assessments results into actual improvements in the patients' emotional well-being. No significant financial relationships to disclose.

An evaluation of the Kakuma Emotional Wellbeing Interview (KEWI)

The success of interventions to address psychosocial issues depends on effectively identifying areas in which assistance is needed, and measuring whether the intervention is providing that assistance. This study evaluates one attempt to develop a locally meaningful assessment of emotional wellbeing (the Kakuma Emotional Wellbeing Interview or KEWI) using both quantitative and qualitative methods. The KEWI was found to have good reliability and validity according to a quantitative study, but a qualitative study highlighted some challenges. The findings of this research illustrate the importance of basing an assessment of psychosocial wellbeing on the aspects of people's lives that are particularly salient to that population, and of finding a way of taking into account the circumstances in which people are actually living. If useful and accurate information is to be obtained, there is a need for real community involvement in the planning and construction of an assessment tool, as well as in the decision-making process regarding how the assessment information is to be used. In addition, a good understanding of the norms and expectations of the population in which the instrument is to be used is necessary, both for the construction of the instrument and the interpretation of results.

Initial Evaluation of Quality Indicators for Psychosocial Care of Adults with Cancer

The American Psychosocial Oncology Society has developed the first indicators of the quality of psychosocial care for cancer patients. This report describes the initial evaluation of these indicators. Medical records of 388 colorectal cancer patients first seen by a medical oncologist in 2006 at seven practice sites were reviewed by trained abstractors whose accuracy was documented by periodic checks. Rates of assessment of emotional well-being within 1 month of a patient's first visit with a medical oncologist ranged from 6% to 84% (mean = 60%; P < .001). Among the 45 patients identified as having a problem with emotional well-being, rates of evidence of action taken (or explanation for no action) ranged from 0% to 100% (mean = 51%; P = .85). A direct comparison showed that pain was assessed more often than emotional well-being in these patients (87% vs 60%, P < .001). Findings show these indicators can be measured easily and reliably, demonstrate variability across practices that suggests potential for improvement, and yield information that can be used to take actions to improve quality. Additional findings suggest that, to date, efforts to promote routine symptom assessment have been more successful for pain than for emotional well-being.