The Effectiveness of an Outpatient Interdisciplinary Team in Reducing Distress with Lung Cancer Patients

Transcription

1 The Effectiveness of an Outpatient Interdisciplinary Team in Reducing Distress with Lung Cancer Patients Shirley Witko Senior Social Worker Sir Charles Gairdner Hospital, Perth Delivering a Healthy WA

2 E 14.1 World Lung Cancer Conference Amsterdam A multi professional health and well being clinic Vanessa Beatie (UK)

3 Background The Literature review Cancer patient high level of unmet needs Lung cancer higher level 1,2 WA statistics The local issues: SCGH data Ancedotal (crisis referrals) The New Comprehensive Cancer Centre 1. Li Girgis 2. Zabora et al.

4 Proposed Benefits Systematic and consistent assessment using a holistic assessment tool All new patients seen Improved access to allied health Reduced waiting times Reduce crisis referrals

5 CaPCREU/Ethics $ 20, 000 CaPCREU application Mentor Admin support Statistician Did not include allied health staff in clinics Application to the Human Research Ethics Committee at SCGH approved as low and negligible risk

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7 Screening Tool Continued Other Problems (Identified by LINC) Falls/near falls Discomfort in sitting/lying Driving Smoking Medications Completing household chores Legal Lack of information about diagnosis, treatment or follow up plan Weight loss

8 Aims Establish the level of distress in lung cancer and mesothelioma patients. Increase access to outpatient multidisciplinary services. Develop a referral pathway Reduce distress and number of concerns in patients who present to the clinic.

9 Referral Pathways Identified which LINC team member could offer assistance for each problem item. Created a cheat sheet.

10 Participant Recruitment Newly diagnosed patients identified at the medical MDT phone contact inviting attendance. Additional newly diagnosed patients identified during clinic drop in. Patients at any stage of disease referred by medical or nursing staff - drop in.

11 LINC Team 2 Social Workers 2 Occupational Therapists (1 - lead investigator) 1 Physiotherapist 1 Dietitian 1 Thoracic Cancer Nurse Coordinator

12 The Clinic Member of the team facilitated the patient s self completion of the Distress Thermometer. Followed by assessment of identified needsdiscussion of problem items ticked, level of distress scored and offer of referrals to LINC members/resources. Level of distress guided response times.

13 The clinic Australian Modified Karnofsky Performance Scale regarding function level. Interdisciplinary screening

14 Post Intervention Readminister Distress Thermometer Participant feedback questionnaire

15 129 invited patients Results 102 (79%) consented, 27 (21%) declined 58% of 102 participants men, 42% women Average age 68

16 Results 25% Mesothelioma 55% Non small cell lung cancer 13% Small cell lung cancer 7% other/unspecified lung cancer 41% Stage 4 32% Stage % Unknown stage

17 Initial Distress Thermometer Problem Items 70% 60% 50% 40% 30% 20% 10% 0% Fatigue Breathing Worry Eating Sleep Weight Loss Sadness

18 60% Referrals 50% 40% 30% 20% 10% 0% Dietetics OT Physio Social Work Nursing Other None

19 Second Distress Thermometer 46% of participants distress decreased 27% of participants distress increased 27% unchanged Median distress score 2.5 Median number of problem items 4.5

20 Percentage of people expressing distress in top 5 distress factors 70.00% 60.00% 50.00% 40.00% 30.00% DT1 DT % 10.00% 0.00% Fatigue Breathing Worry Eating Sleep Sadness Skin Problems Distress Factor

21 Qualitative Results 85% of respondents felt the assessment identified all topics causing them concern. 90% found it helpful having access to all allied health in the one clinic.

22 Qualitative Results 89% felt most or all of their needs had been met. 85% felt LINC helped them deal more effectively with their problems. 93% were satisfied with the clinic. 97% would use the clinic again.

23 Qualitative Results Having someone who has a grasp of the various bits and pieces that go together is better than individual services Worthwhile service. Treats people holistically made me feel like a person. Looks at all the parts that make me I feel that I am more than just a diagnosis

24 Qualitative Results It s nice to be reminded that you can help with things I hadn t thought of Felt like someone cares. Gives you confidence in your problems. Got someone to discuss it with Excellent opportunity. Broadens the oncology department and provides back up

25 Outcomes Dietitian drop in clinic Positive Interdisciplinary team work Improved awareness and use of allied health resources Learning about the processes of research Patient satisfaction Healthcare professionals anecdotal feedback was positive

26 Recommendations Use of distress thermometer vs another tool Challenges of administering tools via phone Allow sufficient time and resources for post intervention follow up The benefit of pre-existing research experience Ongoing promotion to patients and staff of allied health services available