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Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire

Validierung und praktische Implementierung eines multidisziplinären „Distress“-Screeningfragebogens für Krebspatienten

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Abstract

Background

In order to identify cancer patients with psychosocial needs during radiotherapy, a routine screening questionnaire is widely recommended in the literature. Several tools focusing mainly on psychological issues have been developed during the past decade. However, problems with their implementation into clinical routine have been repeatedly reported, due to a lack of practicability for clinicians and nurses. This study reports the compilation of a multidisciplinary screening questionnaire and an analysis of the effectiveness of its implementation into clinical routine at the Department of Radiotherapy, Medical University of Vienna.

Materials and methods

The screening questionnaire is based on a compilation of several subscales from established and validated assessment tools. It focuses on comprehensive information with high a clinical relevance for all professions. In a pilot study, patients’ acceptance was assessed qualitatively. Analysis of missing screening data in consecutively admitted patients reflects the effectiveness of implementation and representativity of the data. A validation analysis of the psychological subscales was performed using external criteria and its internal consistency was tested with Cronbachs’ α.

Results

Qualitative patient acceptance of the screening questionnaire is good. The overall response rate in the screening procedure was 75 %. Missing patient screening data sets arose randomly—mainly due to organizational problems—and did not result in systematic errors. The psychological subscales identify highly distressed patients with a sensitivity of 89 and 78 %, and an internal consistency of 0.843 and 0.617.

Conclusion

The multidisciplinary screening questionnaire compiled in this study has a high patient acceptance, provides reliable and representative data and identifies highly distressed patients with excellent sensitivity. Although requiring additional personnel resources, it can be implemented successfully in clinical routine with benefits for both the patient and the professional team.

Zusammenfassung

Hintergrund

Um gezielt psychosoziale Belastungen von Krebspatienten unter Strahlentherapie zu erheben, wird in der Literatur der Einsatz von Screeningfragebögen in der klinischen Routine empfohlen. In den letzten Jahren wurden bereits einige Screeningfragebögen entwickelt, die sich hauptsächlich auf psychologische Themen beziehen. Wiederholt wurde dabei über Probleme bei der Implementierung in der klinischen Routine berichtet, hauptsächlich aufgrund von mangelnder Praktikabilität für Ärzte und Krankenpfleger. In dieser Arbeit berichten wir über die Entwicklung und den Einsatz eines multidisziplinären Screeningfragebogens sowie über die Effektivität der Implementierung an der Universitätsklinik für Strahlentherapie der Medizinischen Universität Wien.

Material und Methodik

Für die Zusammenstellung des Screeningfragebogens wurden Subskalen bereits etablierter Instrumente herangezogen und multidiziplinäre Information mit hoher klinischer Relevanz für alle Berufsgruppen in den Vordergrund gestellt. In einer qualitativen Pilotbefragung wurde die Akzeptanz der Patienten erhoben. Die Analyse fehlender Screeningdaten im konsekutiven Ablauf beschreibt die Effektivität der Implementierung und Repräsentativität der Daten. Subskalen zum psychischen Status wurden anhand externer Kriterien validiert und deren interne Konsistenz mittels Cronbachs-α-Koeffizient überprüft.

Ergebnisse

Die qualitative Pilotbefragung zeigt eine hohe Akzeptanz der Patienten gegenüber dem Screening. Die Rücklaufquote betrug 75 %, wobei Patienten vorwiegend aufgrund organisatorischer Probleme nicht gescreent wurden und keinen systematischen Fehler verursachen. Die Subskalen zum psychischen Status zeigen eine Sensitivität von 89 und 78 % sowie eine interne Konsistenz von 0,843 bzw. 0,617.

Schlussfolgerung

Die multidisziplinäre Zusammenstellung des Fragebogens zeichnet sich durch hohe Akzeptanz aus, liefert zuverlässige und repräsentative Daten und selektioniert Patienten mit psychosozialer Belastung mit exzellenter Sensitivität. Er konnte erfolgreich in der Routineversorgung implementiert werden, sowohl zum Vorteil der Patienten als auch des Behandlungsteams, erfordert jedoch zusätzlichen Personalaufwand.

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Acknowledgments

We thank all our patients for providing us with information and our team of psychologists Barbara Mikulas, Stefanie Klug, Antonia Nitsch, Iris Hinker, Marlene Keil and Hannah Eberle for their invaluable contributions. All authors have read and approved the manuscript.

Conflicts of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    K. Kirchheiner MSc, A. Czajka, E. Komarek, G. Hohenberg, R. Pötter & W. Dörr

  2. Department of Psychology, Sigmund Freud Private University Vienna, Vienna, Austria

    E. Ponocny-Seliger

  3. Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria

    W. Dörr

Authors
  1. K. Kirchheiner MSc
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  2. A. Czajka
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  3. E. Ponocny-Seliger
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  4. E. Komarek
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  5. G. Hohenberg
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  6. R. Pötter
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Correspondence to K. Kirchheiner MSc.

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Kirchheiner, K., Czajka, A., Ponocny-Seliger, E. et al. Validation and practical implementation of a multidisciplinary cancer distress screening questionnaire. Strahlenther Onkol 189, 573–578 (2013). https://doi.org/10.1007/s00066-013-0348-8

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  • DOI: https://doi.org/10.1007/s00066-013-0348-8

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