Transcript Document

PSYCHOSOCIAL SCREENING
IN A GYNAECOLOGICAL
ONCOLOGY SERVICE IN
ADELAIDE
Psychosocial screening in a
gynaecological oncology
service in Adelaide
Catherine M Burns, PhD
Senior Research Fellow, School of Medicine, Flinders University, South Australia
Cecily Dollman BSW,
Team Leader, Cancer Services, Social Work Department, Royal Adelaide Hospital
Kylie Smith BSW
Local Social Worker, Cancer Services, Social Work Department, Royal Adelaide
Hospital
Social Justice & Health
• A Healthier Future for all Australians
– Report of the National Health & Hospitals Reform
Commission. June 2009
• Key Points of Governance
–
–
–
–
–
–
People and family-centred
Equity
Shared responsibility
Promoting wellness & Strengthening prevention
Comprehensiveness
Value for Money
Population Growth & Social Justice
Australia’s Population – 1951 - 2030
Australian Population 1951-2001 & Projections to 2030
450000
400000
300000
Series1
250000
Series2
200000
Series3
150000
100000
50000
0
Ju
n_
1
Ju 95
n_ 1
Ju 1 95
n_ 6
Ju 1 96
n_ 1
1
Ju 96
n_ 6
Ju 1 97
n_ 1
1
Ju 97
n_ 6
Ju 1 98
n_ 1
1
Ju 98
n_ 6
Ju 1 99
n_ 1
Ju 1 99
n_ 6
2
Ju 001
n2
Ju 00
n- 6
2
Ju 011
n2
Ju 01
n- 6
2
Ju 02
n- 1
2
Ju 026
n20
30
Total Population
350000
Date of Census
Australian Population Distribution
1967-2027
Australia's Population X Age 1967-2027
80
70
% Total Population
60
50
1967
2007
40
2017
2027
30
20
10
0
0-14
15-64
65-84
Age Groups
85+
Social Justice and Cancer Care
WHO 2003 Report Cancer trends to 2010
–
–
31% increase Northern Europe
51% in North America
Australia AIHW Report 2008
• INCIDENCE 100,000 new cases of cancer in 2005, projected to
grow by over 3,000 each year.
– QLD 18,483 new cases in 2008.
• PREVALENCE x 8 = close to one million living with cancer.
• Around 150,00 people living with cancer in QLD
• 38,000 deaths from cancer in Australia in 2005.
•
Place of Death
Aged trends (Gomes & Higginson 06) absolute increase in deaths will commence in 2012
and last until 2050
• AIHW (09) first national linkage of hospital and residential aged data found
25% of people died within 4 months of entering a RACF
Place of Care (Agar M et al 08)
• Two conversations – “place of care is not a euphemism for death”
Barriers to Treatment:
Role of
Screening
• Social Justice
– Place of care and place of death
• Threat of increased barriers to treatment & care
– Ageing population and increases in absolute numbers of deaths
“expansion should occur in terms of home-based services and
improvements at the interface between inpatient and
community care, to facilitate a move towards home”….
• Role of screening
– Identification of the vulnerable.
• A scientific methodology needed
• clinical audits to undertaken over time
• GUARANTEE commitment to equity is achieved.
• Where to start?
– Cancer Psychosocial Care
– social work practice model for extension to other areas of health
QIP Initiative at RAH
Screening for Distress
• Oncology Day Centre – 2007
– Funding Provided by Prof Dorothy Keefe
– Convenience sample only used 60% scored high
• This successful preliminary work provided a platform, to
implement a systematic screening approach
• Then sought to respond to highly vulnerable population
– women with gynaecological cancers
Method of Recruitment
• Obtained ethics approval
• Project undertaken over 5 weeks 7 October – 7
November 2008
• The were no exclusions defined in the population
• Recruitment procedure
– Nursing staff integral to the initiative
– Women asked to complete a survey form twice –
before and after their medical appointment
– This sought to control for pre-consult distress
• Women with high distress scores were referred same
day to clinic social worker for follow-up and assessment
Extreme
Distress
Please circle the number
(0-10) that best describes
how much distress
(mental or physical pain
or suffering) you have
been experiencing in the
past week, including today.
No
Distress
Characteristics Gynaecology Clinic Population
Marital status
•
•
•
•
Single
Married
Divorced/separate
Widowed
Religion
18.9
52.8
17.3
8.7
Employment status (n=107)
•
•
•
•
Employed
Home duties
Retired/pension
Unemployed/student
Place of Residence
• Metropolitan
• Rural
30.8
18.7
45.8
4.7
66.9
33.1
•
•
•
•
•
None
Anglican
Catholic
Uniting
Other
Income support
Occupation
•
•
•
•
•
•
•
Professional
Semi-prof/adv clerical
Clerical
Home duties
Retired
Pensioner
Unemployed/student
44.1
15.7
11.8
7.1
21.3
30.7
10.3
8.4
12.1
18.7
10.3
35.5
4.7
Characteristics Gynaecology Clinic Population
Major Diagnoses x Age
%
Gynaecology Clinic-Diagnoses x Age
45
40
35
30
25
20
15
10
5
0
Ovarian
Endometrial
Cervical
Benign/pre-ca
<45
45-54
55-64
Age groups
65-74
74+
Treatment - modalities
• Surgery
• Chemotherapy
• Radiotherapy
94.5
35.4
21.3
• Currently on treatment
37.0
• Recurrence
• Palliative
15.7
2.4
FINDINGS: Global Distress Score 0- 10
Pre and post appointment
Scale
Pre-Test N= 107
%
Post-test N= 101
%
0
20.6
36.6
1
15.9
13.9
2
8.4
12.9
3
16.8
6.9
4
3.7
5.9
5
7.5
7.9
6
7.5
3.0
7
7.5
5.9
8
7.5
4.0
9
6.5
1.0
10
1.9
2.0
DT Distress Scores
Pre & Post Scores P=<0.001
DT
Pre-Test
%
Post-test
%
60
50
40
0 -1
36.8
50.5
30
2-4
29.2
25.7
20
5-7
18.9
16.8
10
8-10
15.1
6.9
0
DT 0-1
DT 2 -4
DT 5 -7
DT 8-10
Pre-test
Post-Test
DT Scores
Time 1 & 2
x
Clinical Features
60
50
40
DT1 0-4
DT1 5-10
DT2 0-4
DT2 5-10
30
20
10
0
Currently on treatment Have recurrent disease
DT Scores Time 1 & 2 X Age
60
50
40
DT_1
DT_1
DT_2
DT_2
30
20
10
0
<55 yrs
55-65 yrs
>65 yrs
0-4
5 -10
0-4
5 -10
Summary of Global findings
• 24 % of patients report distress scores above the cut-off
level after their medical consultation
• Cross-tabulation of pre and post test scores confirms a
dynamic factor operating
• Those currently on treatment more likely to be
distressed
• Interestingly those with recurrent disease reported lower
levels
• Age is an important association in patients’ levels of
distress
– Younger women are likely to be much more distressed
– Older women are more likely to have no distress at all
Specific Areas of Concern
Practical
Housing
Insurance
8.41
%
.93
%
Work/school
12.15 %
Transport
10.28 %
Childcare
1.87 %
Specific Areas of Concern
Family
Dealing with partner
12.15
%
Dealing with children
11.21
%
Specific Areas of Concern
Emotional
Worry
46.73 %
Fears
27.70 %
Sadness
26.17 %
Depression
16.82 %
Nervousness
28.04 %
Loss of interest and activities
23.36 %
Specific Areas of Concern
Spiritual/Religious & Physical
Spiritual/Religious
%
1.8
PHYSICAL
Pain
Nausea
Fatigue
38.32
22.43
44.86
Sleep difficulties
Getting around
39.25
21.50
Bathing/dressing
Breathing
Mouth sores
10.28
9.35
6.54
Specific Areas of Concerns
Eating
Indigestion
Constipation
Diarrhea
Changes in urination
Physical (cont’d)
%
16.82
13.08
14.02
48.60
8.41
Fever
Dry Skin
Nose dry/congested
7.48
33.64
17.76
Tingling hands/feet
Feeling swollen
24.30
19.63
Sexual
Appearance
Memory/concentration
9.35
14.95
25.23
In Summary
• Case ascertainment has essentially remained unchanged in most
Australian hospitals for over 50 years
– Drs & nurses identify people whom they think could do with a social
work referral.
• Simple screening is a first step towards professional responsibility
for psychosocial care
• Implemented as QI measure
– Developing multidisciplinary responses appropriate to individual health
setting
– Clinical audit trail
• Most importantly of all, it is a real attempt to guarantee that the
most vulnerable people do not fall through the cracks
• Finally, it provides important irrefutable data for energetic, strategic
Directors of Social Work services to argue for increased service
provision which will be needed within the next few years