Authors (including presenting author) :
KOK SS(1), Lam CP(1), Tang PY (1)
Affiliation :
(1)Department of Surgery, United Christian Hospital
Introduction :
Psychosocial aspects of colorectal cancer (CRC) patients are not screened and addressed. No structured protocol is available. The project aims at implementing psychosocial screening for all newly diagnosed CRC patients and refers those screened positive to clinical psychologist (CP) and medical social worker (MSW) for assessment and support. It also aims at incorporating screening into the routine workflow.
Objectives :
This quality improvement project aims to raise healthcare providers’ awareness and increase early identification of colorectal cancer patients who were at high risks of mental distress. It sets a structured process and guideline with the use of a validated screening tool Depression Anxiety Stress Scale 21 (DASS 21) for screening and referring mental distress patients. It also aims at incorporating distress screening as standard patient centered care and using the Plan Do Study Act (PDSA) model guided healthcare practice change and determines outcome measures.
Methodology :
A Quality Improvement Team consisting of colorectal surgeons, nurses, CP
and MSW was formed. A retrospective review of patients to see if any psychological distress screening was done prior to this project was performed. All newly diagnosed CRC patients were screened by a structured and validated Depression Anxiety Stress Scale (DASS21) questionnaire. Those screened extremely severe/ severe in depressive and anxiety score were referred to CP and MSW for support and assessment. DASS21 was repeated 3 months after the diagnosis. Patients’ demographics, disease status, number screened positive and referred, treatment received and follow up DASS21 score were collected and analysed. 2 PDSA cycle were implemented for continuous assessment and improvement throughout the project.
Result & Outcome :
This project included 115 patients with 23 (20%) and 65 (57%) patients screened positive with depression score>20 and anxiety score>14 respectively. 13% and 43.5% were referred to CP+MSW and MSW only respectively. There is reduction of mean depression score from 25->6 and mean anxiety score from 22->5 in follow up DASS21. Screening rate raised from 80->100% after 2 PDSA cycle. 100% screened positive patients were referred to CP and MSW for assessment.
This pilot project involving multidisciplinary team in which psychosocial
aspect of CRC patients are addressed and screened. It is now incorporated into our routine workflow.
