Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study

Abstract

Background: Few studies have reported on the impact of screening on patient outcomes or clinical practice and research describing the implementation of psychosocial screening in rural services is scarce.

Aims: This study investigated the feasibility and utility of a psychological screening program in Australian rural oncology clinics.

Subjects & methods: A total of 83 newly diagnosed adult cancer patients, seen at one of three rural outpatient oncology clinics participated in this study.

Results: Nineteen of forty-three (44%) participants in the screening phase scored above cut-off score on the Distress Thermometer (DT), a validated screening tool for distress in cancer patients. The DT had acceptable sensitivity (86%) and specificity (77%) as a screening tool using another validated self-report measure of psychological symptoms, the Psychological Symptoms Subscale of the Somatic and Psychological Health Report Short form, as a'gold standard'. Screening with the DT did not significantly increase the rate of referrals to psychosocial staff of distressed individuals. However, screening with the DT reduced time to referral. The screened group reported significantly greater unmet needs in univariate (P = 0.01) and multivariate analyses (P = 0.01).

Conclusions: Psychological screening did not increase rates of referral to psychosocial support staff for patients with psychological morbidity. However, given the methodological limitations of this pilot study, the results should be interpreted with caution. The DT was found to have acceptable sensitivity and specificity to detect likely cases of psychological morbidity. Barriers to implementation of psychological screening in rural clinics and recommendations for future psychological screening programs at outpatient oncology clinics are discussed.