Refinement of Distress Screening Procedures Workflow in a Lung and Esophageal Oncology Clinic: A DNP Quality Improvement Project

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The Ohio State University

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Problem: Psychosocial distress in cancer patients often go underdiagnosed or otherwise inadequately treated, and negatively impact multiple patient-centered and other outcomes. Purpose: The purpose of the proposed project was to: (1) refine implementation of psychosocial distress care procedures and referral processes for patients with newly diagnosed lung and esophageal cancer at the CCC, (2) conduct a process evaluation of the workflow procedures refinement; (3) complete a summative evaluation of the usefulness, usability, and desirability of the refined workflow procedures; and, (4) examine screening rates for psychosocial distress pre- and post- project implementation. Methods: Consenting providers and clinic staff (n=13) were asked to utilize the PROMIS 10 screening tool and referral recommendations procedures with one newly diagnosed lung or esophageal cancer patient in the Thoracic surgery outpatient clinic. Refinements were made to the screening and referral procedures by providers and staff as requested. Modified procedures were then utilized by providers and clinic staff with additional newly diagnosed lung or esophageal cancer patients (n=15). A final (summative) evaluation of the final version of the workflow procedures was obtained via a Usability, Usefulness, and Desirability (UUD) survey. Aggregate administrative data was provided to the DNP student at the conclusion of the project to evaluating changes in screening rates from pre- to post-implementation of the refine workflow procedures. Findings: All mean scores for individual UUD survey items met or exceeded the 4.0 benchmark ("agree") on 1-5 rating scale established for project success. Implementation field notes documented the iterative workflow refinements and favorable feedback for the appropriateness of the revisions to workflow procedures and related implementations activities. Aggregate administrative data provided to the DNP student at the conclusion of the project by the James CCC Director of Social Work demonstrated substantial and statistically significant increases in screening rates occurred from pre-implementation (å Months 1-3 = 35) to implementation (å Months 4–6 = 169), c2(2) = 10.195, p < .01. The mean score change in screening rates from preimplementation to implementation was of a large effect size and statistically significant, t (2,2) = - 2.58, p < .05, Cohen's d = 2.10. Conclusions: The refined PROMIS 10 procedure workflow was successfully implemented and favorably evaluated by providers and clinic staff. Modifications to the PROMIS 10 workflow led to significantly increased compliance and utilization of the screening tool, increased referrals to specialist providers, a new method for educating patients on stress and coping in the context of cancer, and lastly positive receptiveness encouraging the continued use of screening/referring patients in clinical practice.



psychosocial distress, cancer, screening, process evaluation