Tina Harralson,1 Linda Toche-Manley,1

Laura Dietzen,1 Grant Grissom,1

Erin O’Hea,2 & Edwin Boudreaux 2

1 Polaris Health Directions, Langhorne, PA2 University of Massachusetts Medical School, Worcester, MA

With NIH funding, in 2006, Polaris staff and UMass Medical School researchers specializing in Psycho-oncology began work on filling a need in cancer care:

An automated psychosocial assessment validated and normed for cancer patients

Real-time referral and reporting system

Tailored patient education materials

Recommendations:

… screen for distress and psychosocial health

… refer to appropriate care

…follow-up and reevaluation

In 2007 IOM published a report “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs”

In 2012 the Commission on Cancer released a new accreditation standard to take effect in 2015

Standard 3.2: Psychosocial Distress Screening

Distress should be recognized, monitored, & documented

Tool: Preference for standardized, validated instruments with established clinical cutoffs

Assessment: Identify psychological, behavioral and social problems that interfere with the ability of patients to participate fully in their health care and manage their illness and its consequences

Referral: Link with psychosocial services offered on-site or by referral.

Documentation: Screening, referral or provision of care, and follow-up are documented in the patient medical record to facilitate integrated, high-quality care.

The Polaris Oncology Distress Management System is a valid tool that provides:

Features have been tested among cancer patients, oncology

providers, and mental health providers.

MD Anderson, Cooper Hospital (NJ) and UMass Medical

More than 1000 cancer patients completed the assessment

during the NIH-funded randomized controlled trial.

Screening Referral Follow-up Documentation

Science and Technology Behind the System

Published, peer-reviewed

Valid/reliable instrument

Psychometrically sound

Normed on cancer patients

In ACoS Best Practice Repository

More than 250,000 patient assessments completed with technology

Secure Web Platform; HIPAA-compliant

Polaris Oncology Distress Management System

Secure, Web-based, automated assessment of patient’s psychosocial needs

Completed by patient on laptop or notebook in 5-10 minutes /6th grade

reading level

Real-time reports tailored to patient and provider

Timely referrals

Monitor patient progress

Customizable by site

EHR integration via HL7 interface; integrate care notes

Aggregate reports

All Patients are Asked Questions in Core Areas:

Distress

Counselor for emotional issue

Support Resources/Social Support

Functional Disability

Physical Symptoms/Side Effects & Severity

Alcohol Use

Tobacco Use

Patients with Distress > 4

Asked additional questions regarding:

Mental Health History

Diagnoses – Hospitalizations – Medication - Therapy

Overall well-being

Depression

Anxiety

Cancer-related PTSD

Functional Disability

Assessment Screenshot

• 95% unassisted completion rate• Easily completed by older adults and

persons without computer experience.

Reports produced in real-time…

• View on Web

• View in EHR

• Print hard copy

Provider Report Care Plan NotesPsychosocial Functioning Social Work- Physical Therapy

Psych History/ Action Summary Genetic Counseling- DietitianSymptoms and Side Effects

For this patient, only 15% of cancer patients have higher overall distress, which is a composite score that includes questions on the severity of patient’s depression, anxiety, overall well-being, and functional disability.

Patient’s Percentile Score for Psychosocial Functioning

Patient Feedback Report

•Description of Report

•Mental Health Referral

•Support Information

Referrals and Supports

Patient Feedback Report

Patient Feedback Report

Info on relationships & sexual intimacy

Info on managing pain & side effects

Patient Feedback Report

Referrals for smoking and alcohol

Diet, exercise, and lifestyle information

Patient Feedback Report: Action Plan

I will talk to my doctor about quitting smoking…

I will find a support group…

Info on clinical trials or genetic counseling

Monitoring Report

______________________________ ______________________________ __________ __________

Nurse Signature Printed Name Date Time

______________________________ ______________________________ __________ __________

Patient Signature Printed Name Date Time

NAME: BENES, ELAINE DATE: 4/18/2012

PSYCHOSOCIAL HEALTH ASSESSMENT Healthcare Provider Report

CANCER CENTER LOGO

Social Work

DEPRESSION SCORE 70% OR GREATER

ANXIETY SCORE 70% OR GREATER

FUNCTIONAL DISABILITY 70% OR GREATER

Patient is interested in mental health services

Patient is interested in attending an educational program

Patient has insurance/financial concerns Patient is having difficulty with ADLs

Patient is interested in advanced directives

Patient is a caregiver Patient is interested in joining a support group

Patient is interested in receiving educational materials

Patient is interested in learning about mind/body services

Patient is interested in learning about relaxation techniques

Patient is interested in learning about exercise

Palliative Care

Patient is over the age of 80 Patient is experiencing pain at an 8 or higher on a scale of 1-10

Patient lives alone Patient is experiencing shortness of breath

Patient has been hospitalized twice in the past 3 months

Patient’s functional disability score is > = 4

Patient has been diagnosed with head and/or neck cancers

Pain is not relieved by medication

Physical Therapy

Fatigue score is at 7 or above

Swelling in arms or legs

More Information

Patient is interested in learning more about genetic counseling

Patient is interested in more information regarding clinical trials

Dietitian

Patient is experiencing the following symptoms: No appetite, Vomiting, Difficulty with bowel movements (Diarrhea or Constipation), Problems Swallowing, Mouth Sores, Taste Changes

Patient has experienced a 5% weight loss in the past month

Patient has experienced a 7.5% weight loss in the past three months

Patient has experienced a 10% weight loss in the past six months

PSYCHOSOCIAL HEALTH ASSESSMENT Healthcare Provider Report

CANCER CENTER LOGO NAME: BENES, ELAINE DATE: 4/18/2012

Monitors psychosocial, side effects, and lifestyle changes over time

Progress notes for Oncology team

Publications O’Hea EL, Cutillo AS, Dietzen L, Harralson T, Grissom G,

Person S, Boudreaux ED. The Mental Health and Dynamic Referral for Oncology (MHADRO): Methodology of a multi-site Randomized Control Trial. Contemporary Clinical Trials. In press.

Boudreaux ED, O’Hea EL, Grissom G, Lord S, Houseman J, Grana G. Initial testing of the Mental Health Assessment and Dynamic Referral for Oncology (MHADRO). Journal of Psychosocial Oncology, 2011;29:83-102.