Psychosocial Evaluation Research Articles

Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT. First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters. The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient=0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient=-0.66). These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.

Development of a functional and psychosocial evaluation toolkit using mixed methodology in a community-based physical activity program for childhood cancer survivors.

The evidence demonstrating the benefits of exercise and PA in patients and survivors of childhood cancer has been translated into a handful of community-based programs, such as the Pediatric cancer patients and survivors Engaging in Exercise for Recovery Program (PEER). To support the translation of research to practice, the next step in knowledge translation is to evaluate program effectiveness. An evaluation must consider the goals of the PEER program, feedback from key stakeholders, and logistics of this program. Thus, the purpose of this study was to develop an evaluation toolkit with an algorithm for the implementation of the PEER program. Semi-structured interviews were conducted with three different groups (stakeholders in pediatric oncology, PEER parents, and PEER participants). The interviews were transcribed and coded by two independent reviewers. Key themes extracted from the interviews were split into physical and psychosocial themes. The most reported psychosocial themes were quality of life (QOL), fatigue/energy levels, fun, and cs; and physical themes included motor skills, physical literacy, and physical activity levels. Tools were compiled into the evaluation based on key themes identified as well as logistics of PEER. An algorithm was developed to tailor the evaluation to participants based on age and mobility. To date, this is the first evaluation toolkit and algorithm developed for a specific community-based PA program, the PEER program. The next step in knowledge translation will be to implement the evaluation to assess feasibility and share the evaluation for adoption within other developing programs.

Artificial intelligence to identify harmful alcohol use after early liver transplant for alcohol-associated hepatitis

Early liver transplantation (LT) for alcohol‐associated hepatitis (AH) is the fastest growing indication for LT, but prediction of harmful alcohol use post‐LT remains limited. Among 10 ACCELERATE‐AH centers, we examined psychosocial evaluations from consecutive LT recipients for AH from 2006 to 2017. A multidisciplinary panel used content analysis to develop a maximal list of psychosocial variables. We developed an artificial intelligence model to predict post‐LT harmful alcohol use. The cohort included training (N = 91 among 8 centers) and external validation (N = 25 among 2 centers) sets, with median follow‐up of 4.4 (IQR 3.0–6.0) years post‐LT. In the training set, AUC was 0.930 (95%CI 0.862–0.998) with positive predictive value of 0.891 (95%CI 0.620–1.000), internally validated through fivefold cross‐validation. In the external validation set, AUC was 0.692 (95%CI 0.666–0.718) with positive predictive value of 0.82 (95%CI 0.625–1.000). The model identified specific variables related to social support and substance use as highly important to predict post‐LT harmful alcohol use. We retrospectively developed and validated a model that identified psychosocial profiles at LT predicting harmful alcohol use post‐LT for AH. This preliminary model may inform selection and post‐LT management for AH and warrants prospective evaluation in larger studies among all alcohol‐associated liver disease being considered for early LT.

A148 Is Universal Preoperative Psychosocial Evaluation Warranted in the Bariatric Population?: Analysis of a Single Center Experience

A148 Is Universal Preoperative Psychosocial Evaluation Warranted in the Bariatric Population?: Analysis of a Single Center Experience

“Who am I to say?” Dutch care providers' evaluation of psychosocial vulnerability in pregnant women

Maternity care increasingly focuses on evaluating psychosocial vulnerability during pregnancy. Research and nationwide (public health) programs, both in the USA and Europe, led to the development of new protocols and screening instruments for care providers to systematically screen for psychosocial vulnerability in pregnant women. However, standardised screening for vulnerability is complex since it requires discussion of sensitive issues. Women may fear stigmatisation and may have limited trust in their care providers or the health system. Our study contributes to the growing field of client-facing risk work by exploring care providers' interpretations and evaluation of psychosocial vulnerability in pregnant women. Drawing on semi-structured interviews with Dutch maternity care providers, we explore how they conceptualise risk and vulnerability and identify ‘vulnerable pregnant women’ in their practices. We find that care providers conceptualise ‘vulnerability’ as primarily based on risk, which contributes to an imbalanced focus on individual mothers, rather than on both parents and the social context. Our findings highlight care providers' concerns around ‘care avoidance’, seen as a risk factor affecting ‘vulnerability’ during pregnancy and as a possible consequence of risk screening. The care providers we interviewed employ “in between-strategies” based on intuition, emotion, and trust to skillfully attend to the risk that comes with risk work, in terms of its potential impact on relationships of trust and open communication. We conclude that ‘vulnerability’ should be understood as a multi-layered, situated and relational concept rather than simply as an epidemiological category. Since a trusting relationship between pregnant women and care providers is crucial for the evaluation of vulnerability, we reflect critically on the risk of standardised perinatal psychosocial risk evaluations. Policy should recognise providers' “in between-strategies” to embed epidemiological understandings of risk in the context of everyday risk work.

Psychosocial Evaluation and Rehabilitation for Organ Transplant Recipients

臓器移植レシピエント適用基準ガイドラインには，適用および禁忌の両方に精神医学および心理社会的側面に関する記載があることが多い．患者の治療に対する理解，サポート機能や精神的安定性およびアルコールを含む薬物使用が移植予後に多大な影響を与えるためである．心理社会的評価は移植医療に精通した精神医療従事者が行うことが多いが，これまで各評価者の判断に依存してきた．現在，国際的に広く使用されているStanford Integrated Psychosocial Assessment for Transplantation（SIPAT）は，客観的に移植予後に関連する心理社会的要因を測定することが可能なツールである．移植後も抑うつや不安，認知機能低下などの精神症状は出現することがあるが，リハビリテーション医療が果たす役割は大きい．

Relationship of Resilience Factors With Biopsychosocial Markers Using a Comprehensive Home Evaluation Kit for Depression and Suicide Risk: A Real-World Data Analysis.

ObjectivesAdverse childhood experiences (ACEs) are fundamental factors in developing depression with increased suicide risk. Resilience is considered an important protective factor that can prevent trauma survivors from developing depression. We developed a home evaluation kit for a comprehensive assessment of bio-psycho-social factors related to depression and suicide. This kit contained a psycho-social evaluation battery, named the Protective and Vulnerable factors battery questionnaire (PROVE) comprising depressive symptoms and suicide risk, as well as various depression-related psychosocial factors, such as ACE, resilience, mentalization capacity, and attachment, via online survey tools. Furthermore, salivary cortisol levels were used as biological indicators to assess the hypothalamus-pituitary-adrenal axis function.MethodsReal-world data analysis was made out of data collected from participants who visited CHEEU Counseling center or Gangnam Severance hospital for mental health check-ups. The participants were put into three mental state groups (green-normal, yellow-borderline, and red-risk) depending on the result of PROVE battery. The difference between psychosocial factors and salivary cortisol indicators by the group was identified by analysis of covariance with sex and age as covariates. Linear regression analysis was conducted to find a significant association of resilience score with other bio-psycho-social variables, such as ACE, attachment, mentalization, or post-awakening cortisol concentrations (area under the curve with respect to ground, AUCg). A partial correlation analysis was performed to evaluate the relationship of AUCg with psychosocial factors.ResultsDepression-related psycho-social indicators were significantly different among groups. Insecure attachment and the mentalization problem are negatively influencing factors to resilience. Furthermore, the severity of depression in participants with ACE was also influenced by mentalization problems. AUCg was different according to the PROVE group, presence of ACE, or resilience level. In addition, AUCg showed a positive correlation with resilience score but negative correlations with depressive symptoms, ACE, mentalization problems, and anxiety or avoidance attachment.ConclusionThis study suggests that there are some key factors negatively affecting resilience: insecure attachment and mentalization problems. In groups with ACE, a mentalization problem was suggested as a factor that can increase depressive symptoms. AUCg was associated with resilience as well as several other vulnerable factors of depression, showing its potential as a promising biomarker.

The Validity and Reliability of the Chula COVID-19 Psychosocial Home Isolation Evaluation Tool (CCPHIET)

Background: The growing number of cases presenting with COVID-19 during the pandemic has led to a significant shortage of hospital beds. Many patients may not require hospitalization and can be clinically observed in home settings. We have identified a set of psychosocial factors that correlate with unsuccessful home isolation (HI), which in turn might negatively affect the transmission control in the community. Therefore, we developed the Chula COVID-19 Psychosocial Home Isolation Evaluation Tool (CCPHIET), a new screening tool for assessing the psychosocial suitability for HI. This study examines the CCPHIET’s validity and reliability.Methods: This cross-sectional descriptive study included COVID-19 patients who were deemed to be medically safe for 14-days of HI. The CCPHIET is comprised of eight clinical domains pertinent to HI behavioral compliance and risk for non-adherence. We explored its statistical validity and reliability and discussed the potential utility of this tool.Results: A total of 65 COVID-19 patients participated in this study. Most patients (58.5%) were deemed to be appropriate candidates for HI according to the CCPHIET. The results of this study demonstrate that the CCPHIET has an acceptable content validity (IOC index > 0.5), moderate internal consistency (Cronbach’s alpha = 0.611) and substantial to excellent inter-rater reliability (Intraclass correlation coefficient = 0.944, Cohen’s kappa= 0.627).Conclusions: CCPHIET is an easy-to-use tool for assessing the psychosocial suitability of patients advised for at-home isolation with mild and asymptomatic COVID-19. Its implementation can assist clinicians in identifying and redirecting resources to patients at the highest risk for breaking quarantine and save on unnecessary, costly absolute institutional quarantine for those deemed to be psychosocially fit for full adherence.

Health-Related Quality of Life and Depression Symptoms in a Cross Section of Patients with Advanced Lung Cancer before and during the COVID-19 Pandemic.

Background: Adults with advanced lung cancer experience reduced health-related quality of life (HRQOL) and psychological symptoms at diagnosis. Objective: This study aimed to evaluate whether the COVID-19 pandemic worsened HRQOL among patients recently diagnosed with cancer. Design: We analyzed baseline data from two randomized controlled trials of early palliative care to compare HRQOL and depression symptoms among those enrolled during the pandemic (January 2020 to January 2021) versus prepandemic (March 2018 to January 2019). Setting/Subjects: This cohort included patients recently diagnosed with advanced lung cancer in two multisite studies. Measurements: We used analysis of covariance to calculate adjusted mean differences between groups with the timeframe as an independent variable and HRQOL (using the Functional Assessment of Cancer Therapy-General) and depression symptoms (using the Patient Health Questionnaire-9) as dependent variables, adjusting for age, gender, relationship status, performance status, symptoms, and time since diagnosis. We tested for an interaction between the COVID-19 timeframe and relationship status. Results: Neither HRQOL (adjusted mean difference -1.78; p = 0.137) nor depression symptoms (0.06; p = 0.889) differed between patients enrolled pre-COVID-19 (n = 665) relative to those enrolled during COVID-19 (n = 191) in adjusted analyses. Relationship status moderated the effect of the COVID-19 timeframe on HRQOL; unmarried patients experienced worse HRQOL during COVID-19 (adjusted mean difference: -5.25; p = 0.011). Conclusions: The COVID-19 pandemic did not further reduce HRQOL or increase depression symptoms among patients recently diagnosed with lung cancer, but did worsen HRQOL for unmarried patients in moderation analysis. Psychosocial evaluation and supportive care are important for all patients, particularly those with limited social support. Clinical trial registration numbers: NCT03337399 and NCT03375489.

Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program

Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.

Quality of Life and Depression Symptoms in a Cross-Section of Patients with Advanced Lung Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic (RP322)

Outcomes1. Evaluate the effect of the COVID-19 pandemic on quality of life (QOL) and depression symptoms among patients recently diagnosed with lung cancer2. Apply the results of these analyses to identify patients with newly diagnosed cancer at risk of worse QOL or psychological symptoms during a pandemic or other major crisis in order to allocate supportive care resourcesImportanceAdults with advanced lung cancer commonly experience reduced quality of life (QOL) and psychological symptoms at diagnosis. The COVID-19 pandemic has caused universal distress, but whether it has worsened the experience of patients recently diagnosed with cancer is unclear.Objective(s)This study evaluates associations between the COVID-19 pandemic and QOL and depression among adults with newly diagnosed advanced lung cancer.Method(s)We analyzed baseline data from two randomized controlled trials of early palliative care for patients recently diagnosed with advanced lung cancer (n = 856) to compare QOL and depression among those who enrolled during the COVID-19 pandemic (March 2020 to January 2021) relative to those enrolled prior to the pandemic (March 2018 to January 2019). We used analysis of covariance with the COVID-19 timeframe as the independent variable and QOL (using the Functional Assessment of Cancer Therapy–General score) and depression (using the Patient Health Questionnaire–9 score) as dependent variables, adjusting for age, gender, relationship status, performance status, lung cancer symptoms, and time since diagnosis. We also tested for an interaction between the COVID-19 timeframe and relationship status.IV. ResultsThere was no difference in QOL (adjusted mean difference –1.78; p = 0.137) or depression (0.06; p = 0.889) between patients enrolled before COVID-19 relative to those enrolled during COVID-19 in adjusted analyses. Relationship status moderated the effect of the COVID-19 timeframe on QOL; unmarried patients enrolled during the pandemic experienced significantly worse QOL relative to unmarried patients enrolled pre-pandemic (adjusted mean difference: –5.25; p = 0.011).V. Conclusion(s)The COVID-19 pandemic did not further reduce QOL or increase depression overall for patients recently diagnosed with lung cancer, which suggests that QOL reflects other factors, such as symptoms, that do not vary with this external crisis. Reduced QOL among unmarried patients points to increased supportive care needs.VI. ImpactThese results emphasize the profound effect of a new diagnosis of cancer on QOL and highlight the need for psychosocial evaluation and supportive care for all patients.

Exploring gender, psychiatric symptoms, and eating behaviors as predictors of attrition to bariatric surgery

BackgroundOnly a small proportion of eligible individuals undergo bariatric surgery. The purpose was to examine attrition to surgery and whether psychiatric symptoms and eating behaviors differentially predicted attrition among men and women. MethodData was collected from a retrospective chart review of 313 patients who underwent a pre-surgical psychosocial evaluation. ResultsThe overall attrition rate was 33.5%; 42.6% of men and 31.7% of women experienced attrition. In the multivariate analysis of the entire sample, White patients (OR = 2.33, CI: 1.33, 4.08) and those without a history of binge eating (OR = 2.71, CI: 1.23, 5.97) were more likely to undergo surgery. In a multivariate analysis of women only, race and binge eating independently predicted attrition; however, no factors significantly predicted attrition among men. ConclusionsFactors identified at the pre-surgical psychosocial evaluation can identify patients at risk for attrition, and these factors may differ for men and women.

Psychogenic nonepileptic seizure: An empathetic, practical approach

Psychogenic nonepileptic seizure (PNES) is often misdiagnosed as epilepsy, leading to unnecessary treatments and procedures, as well as failure to engage patients in needed mental health care. To establish an accurate diagnosis, video electroencephalography (EEG) in the context of and simultaneous with a comprehensive neurologic and psychosocial evaluation is recommended for any patient with seizures that are not responding to treatment. Delivering the diagnosis with empathy and respect is a crucial component of care that helps patients establish trust with caregivers and follow treatment recommendations. Effective treatment is available, highlighting the importance of early diagnosis to avoid unnecessary and potentially harmful treatment. But there are many barriers to care, including provider misperceptions, lack of acceptance of the diagnosis, poor patient engagement with treatment, and lack of access to care.

Social Responsiveness and Psychosocial Functioning in Adults with Prader-Willi Syndrome.

Although various studies have investigated symptoms of autism spectrum disorder (ASD) in Prader–Willi syndrome (PWS), little is known about the consequences of these symptoms, especially in psychosocial function. We aimed to explore ASD symptoms in adults with PWS with special attention to psychosocial functionality. This cross-sectional study included 26 adults (15 women) with PWS who attended a reference unit for rare diseases. Participants’ primary caregivers completed the Social Responsiveness Scale (SRS), and clinicians assessed multidimensional functioning with the Personal and Social Performance Scale (PSP). Impaired social responsiveness was identified in 20 (76.9%) participants, and manifest to marked difficulties in social functioning were identified in 13 (50%). Participants with impaired social responsiveness (SRS ≥ 60) had significantly worse scores in functionality measured with the PSP (U = 12.5; p = 0.009) and with three of the four PSP main areas. Moreover, scores for the Social Cognition domain of the SRS correlated positively with the Socially useful activities (p < 0.05) and Personal and social relationships (p < 0.01) main areas of the PSP. These results suggest that difficulties in social skills should be assessed in all psychosocial evaluations of patients with PWS.

Combining transplant professional’s psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study

ObjectivesLiving donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant...

Restriction of range effects in post-metabolic and bariatric surgery outcomes research: considerations for clinical decision making.

Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups. Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125). Academic medical center, United States. Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco. Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.

Content Validation of the Psychosocial Evaluation of Allergy on Caregivers and Households (PEACH) Tool

Food allergy has been associated with decreased quality of life for children and their families, however currently available assessment tools are limited in measuring the comprehensive psychosocial impact on caregivers. Our purpose was to establish and validate the psychosocial evaluation of allergy on caregivers and households (PEACH) tool to address this need.

Psychological disorders in patients with orthopaedic oncological diseases and their coping strategies.

This study aimed to determine the prevalence and risk factors of anxiety and depression among orthopaedic oncology patients, their quality of life and coping strategies. This cross-sectional study recruited patients from the outpatient orthopaedic oncology clinic at a tertiary institution. Data were collected from self-report questionnaires: Hospital Anxiety and Depression Scale Hospital Anxiety Depression Scale, World Health Organization Quality of Life (WHOQOL-BREF) and Brief Coping with Problems Experienced (Brief COPE). Risk factors were analyzed with multiple logistic regression. 191 patients were recruited. The median age was 39.4 years old (IQR 35.0). 29.8% had anxiety, 16.2% had depression, and 15.2% had mixed anxiety and depression. Quality of life median scores differed significantly between patients with anxiety and no anxiety and patients with depression and no depression (p < 0.001). Patients with mixed anxiety and depression had a more inferior quality of life (p < 0.001). Age, psychological health and radiotherapy were inversely associated with anxiety. Physical and psychological health were significantly associated with less depression. Ongoing chemotherapy was significantly associated with anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. Anxiety and depression are prevalent among orthopaedic oncology patients. Patients with mixed anxiety and depression had a more inferior quality of life. Patients with ongoing chemotherapy had higher risks of anxiety and depression. The commonest coping strategies were denial, behavioural disengagement, venting and self-blame. Psychosocial evaluation followed by appropriate psychiatric referrals and consultations could be established to facilitate orthopaedic oncology patients during their course of treatment.

Predicting Left Ventricular Assist Device Outcomes Utilizing the Stanford Integrated Psychosocial Assessment for Transplant Measure

Objective: Durable mechanical circulatory support is a proven therapy to extend survival for patients with end-stage heart failure (HF). The International Society for Heart and Lung Transplantation guidelines recommend a detailed psychosocial assessment when selecting candidates for durable mechanical circulatory support. Currently, there are no formally validated psychosocial evaluation tools for left ventricular assist device (LVAD) candidacy. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) uses a multidisciplinary algorithm to evaluate the impact of pre-transplant risk factors on post-transplant outcomes. Emerging literature suggests that the SIPAT might be useful for assessing psychosocial risk factors for LVAD outcomes. Methods: A total of 268 consecutive patients (median age 66 years, 84.6% male) with terminal HF were evaluated before LVAD implantation with a SIPAT assessment. Key outcomes included readmission and mortality rates at 30 days and two years. Results: After screening, 234 subjects met the inclusion criteria and were analyzed. The Patient Readiness subscale of the SIPAT was statistically significant in predicting two-year mortality (B = .167, P &lt; .001; Nagelkerke r2 = .106). Scores on the SIPAT did not correlate to 30-day readmission, 30-day mortality, or two-year readmission rates. Discussion: In this study, only the Patient Readiness score was associated with mortality at two-years post-implantation. This research elucidates the potential longer-term impact of psychosocial factors on LVAD outcomes and the SIPAT’s utility in evaluating LVAD candidacy.

Implementing a Tailored Psychosocial Distress Screening Protocol in a Head and Neck Cancer Program.

Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC. Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported. Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3± 14.9 years), with a mean distress score of 4.51 ± 3.35. Of those, 57% (n=163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR]=3.31, 95% CI=1.75-6.26), fatigue (OR=2.43, 95% CI=1.1.7-5.05), anxiety (OR=1.63, 95% CI=1.30-2.05), and depression (OR=1.51, 95% CI=1.04-2.18) were significantly associated with clinical distress (P< .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation. Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized. 4 Laryngoscope, 132:1600-1608, 2022.