Evaluation of an electronic psycho-oncological adaptive screening program (EPAS) with immediate patient feedback: findings from a German cluster intervention study

Abstract

Purpose: Distress screening has become mandatory and essential in comprehensive cancer care. We evaluated an electronic psycho-oncological adaptive screening (EPAS) which assesses objective indicators of care needs and subjectively perceived care needs and subsequently provides patient feedback with individualized recommendations about psychosocial care services.

Methods: Patients were assessed within clusters, i.e., different oncological facilities of the competence network of the University Cancer Center Hamburg (UCCH). Patients in the intervention arm underwent the screening, controls received standard care. Patients were assessed at baseline (t0), 3-month (t1), and 6-month (t2) follow-up. Outcomes included information level and use of/access to nine psychosocial services at UCCH, well-being (GAD-7, PHQ-9, SF-8), and treatment satisfaction (SCCC). Conditional linear and logistic regressions were used to identify screening effects at t1 and t2.

Results: Of 1320 eligible patients across 11 clusters, 660 were included (50%). The average age was 60 years; 46% were female. The intervention was associated with increased information level for all psychosocial services at t1 and t2 (all p < .001), increased use in some of these services at t1 and t2, respectively (p ≤ .02), and better evaluation of access (e.g., more recommendations for services provided by physicians, p < .01). At t2, the intervention was associated with a lower level of satisfaction with disease-related information (p = .02).

Conclusions: EPAS may improve information about psychosocial services as well as utilization of and access to these services. The effect on information level seems not to be generalizable to other aspects of oncological care. Future studies should incorporate novel technologies and condense the procedure to its core factors.

Implications for cancer survivors: The screening may help to enhance self-management competencies among cancer survivors.

Trial registration: The trial was retrospectively registered (2/2021) at ClinicalTrials.gov (number: NCT04749056).

Keywords: Cancer; Distress; Patient-reported outcomes; Psycho-oncology; Quality of life; Screening.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

Flow chart. UCCH, University Cancer Center Hamburg. aClusters were included if they (i) were primary oncology facilities, (ii) treating a high number of patients, and (iii) agreed to participate in the study; each cluster received each condition except for the cluster “Marienkrankenhaus—Private station” which only received control condition owing to too few participants. bSevere physical/mental/cognitive impairment (n = 193), isolated (n = 18), insufficient language skills (n = 68), incompetence to use tablet as assessed by physicians (n = 9). cPhysical/mental burden (n = 32), organizational issues (n = 19), no interest (n = 171), other reasons (n = 59). dSevere physical/mental/cognitive impairment (n = 130), isolated (n = 21), insufficient language skills (n = 23), underage (n = 2). ePhysical/mental burden (n = 14), organizational issues (n = 8), no interest (n = 66), other reasons (n = 5). fWithin clearance of the final data, any cases with unrestorable documentation errors or missing/unclear information on either age, gender, or diagnosis were deleted. gPatient loss mostly due to not sending back the questionnaires or having deceased