Tag Archives: Distress screening

Journeying Beyond the Physical: Addressing a Patient’s Spiritual Concerns

By Susan van der Sommen, MHA, CMPE, FACHE

HC provider cupping patients hand (for web)Based on evidence presented in the Institute of Medicine’s 2008 report, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,” the American College of Surgeons Commission on Cancer (CoC) has phased in a new standard – 3.2: Psychosocial Distress Screening. The goal of utilizing a psychosocial distress screening tool is to ensure patients’ emotional and psychological needs are being addressed – in addition to their physical disease and symptoms.  CoC Standard 3.2 includes the following description of the psychosocial assessment:  “This assessment will confirm the presence of physical, psychological, social, spiritual [emphasis added], and financial support needs and identify the appropriate referrals as needed.”

In an article published in the March/April 2017 edition of ACCC’s journal Oncology Issues, the Reverend Lori McKinley outlines how Mercy Health lived up to its promise to “make lives better – mind, body and spirit” by incorporating a rating for various spiritual concerns of a patient or loved one. The Spiritual Care Team at Mercy recognized that just addressing emotional and physical needs of patients is not enough.  After performing an extensive literature review and developing connections with community-based organizations, the Mercy team made significant quality-related, evidence-based changes to their electronic health record (EHR) to accommodate a new and improved distress screening tool. Learn more about their pilot project here.

Indeed, a patient’s spirituality is directly related to their quality of life and has a direct correlation to giving  patients meaning, a sense of purpose and understanding during a critical time in their lives. In “Spirituality in the Cancer Trajectory,”  author C.M. Puchalski writes that “Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and dying.” Her article goes on to identify the link between spirituality and “inner peace, gratitude and positivity” when facing a life-changing diagnosis such as cancer. She writes that with proper support, a patient may begin to view their cancer diagnosis as a positive life-changing experience, ultimately paying greater time and attention to higher priorities in their lives. This is not possible if a patient’s spiritual needs are not addressed routinely throughout their care.

Puchalski further points out that religion is but one type of expression of spirituality so non-faith based organizations should not dismiss the concept or its importance. In fact, she writes, a majority of patients want their oncologist or healthcare professional to address their spiritual concerns and integrate their needs and wishes into their care plan.

Not surprisingly, this is what the Spiritual Care Team at Mercy discovered during their pilot program. With the addition of four questions addressing spiritual concerns in their distress screening tool, they were able to more effectively connect patients with their faith, alleviate fears, and assist patients with addressing their trepidation at the end-of-life. Isn’t that what all of us want for our patients?

Reference

Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;23(suppl_3):49-55.


Contributing blogger Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network, and Chair of the ACCC Editorial Committee.

 

Medicare Oncology Care Model: Opportunities for Social Work Participation

By Fran Becker, LCSW, OSW-C

ThinkstockPhotos-467463476The oncology community continues to follow developments with the Center for Medicare and Medicaid Innovation (CMMI) Oncology Care Model (OCM), a program that aims to improve patient care, efficiency, effectiveness, and lower costs.

As participating cancer programs implement the changes mandated by the OCM, increased responsibilities for social work are clear.  In fact, under the model, the involvement of, and coordination with, social work is needed in a number of areas.

The OCM mandates that all patients receive patient navigation and supportive services during their treatment. These services encompass assistance in a number of areas, including financial, transportation, and facilitation of follow-up services.

As a component of the OCM, Medicare is requiring the documentation of a comprehensive Care Management Plan described in the National Academies (formerly, known as the Institute of Medicine) report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. All patients are to receive a care plan consisting of 13 items.  Among these, there are two areas that call for social work services:

Advance Care Plans – Social work has been involved in these conversations for some time in many settings. In fact, Medicare has revised payment policies to include advance care planning (CPT code 99497; add-on CPT code 99498). While the physician is the primary provider in advance care planning conversations, members of the cancer care team, including social work and other allied healthcare professionals, have an opportunity to be involved in these conversations

Distress Screening – Another important requirement under the OCM is screening for depression during each episode of care. As part of the patient’s care plan, OCM participants are required to screen and document a plan to address a patient’s psychosocial health needs. While many cancer programs screen for distress using the NCCN Distress Thermometer, Medicare has determined that this tool is not sufficient to screen for depression under the OCM, and asks OCM participants to use the PHQ-2 and PHQ-9 for depression screening.  The PHQ-2 self-report asks two questions to determine if a more extensive evaluation is needed.  If the patient scores at a three or above, the patient is asked to complete the lengthier PHQ-9.  During this meeting, if the patient screens in for depression, social work involvement escalates.  Social work has several options for helping patients, including offering counseling services in-house or referral to an outside agency, referral to the patient’s primary care provider, oncologist, or a psychiatrist. Even if the program is providing clinical social work services, follow-up on these referrals is needed to ensure patients follow through. In addition, social work is required to follow the patient to assess improvement or the need for additional services.

Social workers play an important role in helping OCM participating programs succeed under this innovative new model. Practices that are not participating in the OCM should do a self-assessment in terms of their social work capabilities, and their ability to support patients’ psychosocial health needs. As signaled through CMMI’s inclusion of social work and patient navigation services in the OCM model, this holistic approach to cancer treatment is sure to be the future of oncology care.

If you are a participating OCM practice, be sure to join ACCC’s OCM Collaborative, an online community of OCM practices sharing best practices, tools, and tips to succeed in the OCM. Join today.


Guest blogger Fran Becker, LCSW, OSW-C, is manager of Cancer Support Services, Carl & Dorothy Bennett Cancer Center, Stamford Hospital, and a past member of the ACCC Board of Trustees.

From Distress Screening to Solutions: Patient-Centered Support

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By Don Jewler, Guest Blogger

The Edward and Marie Matthews Center for Cancer Care at the University Medical Center of Princeton at Plainsboro is a New Jersey cancer program with a tall vision to identify distress among their patients, no matter where they are within the organization, and refer them quickly to the help they need. The institution will be honored with a 2014 ACCC Innovator Award for the development of a distress tool that guides clinical staff in making timely and appropriate referrals.

“It’s been amazing how many different issues we have been able to solve for patients with the distress tool,” said Lori McMullen, RN, MSN, OCN, senior oncology nurse navigator. “One patient, for example, was having a really difficult time emotionally coping with cancer. With the distress tool, we could see that he was struggling with his diagnosis. Conversations were started. We were able to make sure he received the psychological help he needed, and that’s a beautiful thing.”

McMullen along with representatives from both outpatient and inpatient nursing staff developed the user-friendly distress tool, which uses a six-point Likert scale scoring system. Patients rank a number of concerns, including weight loss and nutrition, finances, sadness, anxiety, family, and, of course, coping with the disease. A line for “other” allows patients to write in whatever else is bothering them.

“In the outpatient setting, the distress tool is done on paper and entered electronically into each cancer patient’s electronic medical record. For our inpatients, we have worked with our IT department so that the tool is totally electronic” said McMullen.

Commission on Cancer Standard 3.2 (a 2012 standard that must be phased in for 2015) mandates that patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, first visit with a medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit.

“Here, the patient might take the distress tool three or four times during the treatment cycle,” said McMullen. “As clinicians we were worried that our patients would get tired, or even annoyed, that we keep asking them about their distress level, but we have found our patients are happy that we are concerned.” At the University Medical Center of Princeton at Plainsboro, patients are screened for distress in radiation oncology at the first nursing visit after simulation, in the outpatient infusion room at the first chemotherapy visit, at the physician’s office at week five or six if on treatment, at the breast health center after a treatment plan is developed, and at the end of radiation treatment.

McMullen makes sure that referrals to support services are made. She has been the champion for implementing the distress screening tool system-wide.

“It took time to put the new process into the daily routine,” she noted. “Inviting patients to share their problems may not fit into every physician’s time frame. Although it may not yet be second nature for everyone to work the distress tool into their schedule, with gentle reminding we are getting close to 100 percent compliance.”

McMullen will speak at ACCC’s 31st National Oncology Conference in San Diego, Calif. On Friday morning, October 10, 2014, she will discuss techniques and barriers for building and implementing a system-wide distress screening tool. Come listen.

ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.