gms | German Medical Science

Background: Despite a multiplicity of scientifically researched psychooncological screening models it lacks realisation of standardised diagnostic procedures in routine clinical practice. This project was based on the results of a preceding study (n=189) conducted in a surgical acute clinic. According to the HAD Scale (HADS) 26% and to the Horned Questionnaire, short form (HQ-S) 30% of the cancer patients had been proved to be psychosocially distressed, 28% turned out to suffer from psychiatric comorbidity. The HADS and the HQ-S had shown a good performance at the adopted threshold values defined to cover all patients with DSM-IV diagnoses and to obtain the best trade-off between sensitivity and specificity. Purpose of the project was to implement a systematic screening procedure for cancer patients in the above mentioned setting and to determine the challenges of the implementation process.

Methodology: The application monitoring project was accomplished in an 11-week monitoring phase followed by routine application. All patients scheduled for admission received the questionnaire. Screening instruments were HADS and HQ-S completed by socio-demographic and project specific items, adopting the previously established cut-off values for caseness. High scoring patients were contacted by the psychooncologist for further diagnostic evaluation and decision on support and treatment.

Results: In the monitoring phase 269 patients were included. Return rate was between 20% and 76% depending on the logistic arrangements and the effort applied to collecting the questionnaire. Generally patients' acceptance was good. Cancer patients (n=147/55%) dominated the unselected sample. According to HADS 31% and to HQ-S 35% of the cancer patients scored above threshold. Good collaboration with medical staff turned out to be essential.

Conclusions: Implementation of a systematic screening procedure is practicable when using existing institutional structures, routine feedback and continued encouragement of the personnel involved. HADS and HQ-S proved to be appropriate screening measures. Caseness has to be defined on the basis of short, validated instruments at customised cut-off values, adjusted to setting, population and available personal resources. Psychooncological diagnostic procedures in clinical practice should include not only screening but further diagnostic evaluation of highly distressed patients and their direct referral to psychooncological treatment.