Aim
A clinical pathway (CP) for screening, assessing and managing anxiety and depression (ADAPT CP) was introduced in NSW cancer services. This study examined the changes in distress and number and types of problems reported by patients with cancer when the ADAPT CP was implemented.
Methods
Patients from 10 cancer services completed the Distress Thermometer (DT) and Problem List (PL) in clinic or via email, 3-monthly, over 12-months. Distress level was indicated from 0-10 (no distress to extreme distress). Reasons for distress were indicated using the 39 item PL across five domains: practical, family, emotional, spiritual and physical.
Results:
660 patients completed 1,256 screening events over 12 months. Screenings were grouped according to the quarter in which they were completed during the 12-month period (Q1= 173; Q2= 311; Q3= 395; Q4= 377). A higher proportion of screenings indicated lower levels of distress (DT<4, 63-71% over the 4 quarters) than elevated distress (DT≥4, 29-37%). In total, 8,645 problems were reported (Q1= 1,357; Q2= 2,294; Q3= 2,555; Q4= 2,439). On average, more emotional (27-34%) and physical (19-22%) issues were reported than practical (7-9%) and social (8-9%), with a significant decline in the average number of emotional problems reported across time. Worry was the most prevalent emotional concern. Fatigue and sleep issues were the most persistent physical concerns. Insurance/financial issues and concerns around the health of family members were common practical and social concerns, respectively.
Conclusion
The implementation of a CP for identifying and managing anxiety and depression in patients with cancer reduces emotional concerns. Healthcare providers may put in place supportive services or management strategies to address patient needs earlier, as they become more familiar with common problems reported. Concerns around worry, fatigue, issues with sleep, insurance/finances and health of family members, are common and persistent problems for patients with cancer.