Supportive care data
NEMICS collects audit data to inform understanding of: commonly reported problems for specific groups; the spread of supportive care screening and triage and referral activity. Data is used to drive service improvement efforts.
NEMICS Supportive Care Audit
The 2013 – 2014 NEMICS regional supportive care audit was initiated by NEMICS supportive care project officers. This is the first time an audit has been undertaken to identify the supportive care needs of the NEMICS cancer population.
Using the NCCN Distress Thermometer and Problem Checklist, NEMICS health services audited a total of 2183 screens on 1784 individual patients over an 18 month period, 1 January 2013 to 30 June 2014. Patients screened most commonly were those with breast, haematological, colorectal and lung cancers; most screens were completed by a nurse (37%) or specialist nurse (18%).
Screening was undertaken across a range of oncology services: day oncology: 425 screens (20%); specialist clinic: 393 screens (18%); inpatient oncology wards: 243 screens (16%); radiation therapy: 207 screens (10%) and inpatient palliative care unit: 168 screens (8%). Tumour types most commonly screened within units varied, potentially reflecting treatments received and available systems and resources in place to support screening.
In relation to distress scores recorded, approximately half (49%) of the people screened identified a score of 4 or more. Whilst the precise meaning of distress scores is debated, knowledge of the distress scores patients report while attending specific NEMICS oncology services could assist these services to monitor patients and provide self-management support or early interventions to reduce their impact.
A total of 13843 problems were identified across all problem checklist domains on 2048 screens. Screens identified a range of problems regardless of tumour type. Analysis of problem checklist data found that on average each screen recorded 6.78 problems; there was an overall median of 6, a range of 0 to 30 problems and a standard deviation of 5.14.
Total problems recorded by domain were as follows: practical domain 5%; family domain 4%; emotional domain 30%; and physical domain 61%. Different numbers of problems are listed in each domain and this needs to be taken into account when interpreting these figures. Emotional and physical domain problems featured with fatigue and worry being identified by half of the people screened. Problems with nervousness, sadness, sleep, fears, pain, and fears were also commonly reported.
After patients complete the screening tool, a conversation with a health professional assists to clarify the patient’s perception of identified problems. Needs are addressed through information provision, triage and referral. The audit revealed that 855 referrals were made following completion of the screen. The majority of referrals (97%) were made to services provided by NEMICS health services. Services most referred to were: social work (24.2%), dietetics (15.8%), GP/doctor (9.7%) and other (9.5%). Only 24 of the 855 (2.8%) referrals made were made to community services. Interrogation of the Medical record for this audit only included information that was recorded on each health services’ supportive care medical record form; therefore additional referrals may have been made as a result of the screen but were not included in the audit.
NEMICS has analysed data by health service providing opportunities for NEMICS oncology services to review a sample of problems identified by tumour type and screening location in order to consider whether the right supports are in place to address identified needs.