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Alex Mitchell twitter/_alexjmitchell University of Leicester

Screening for Distress Debate. Alex Mitchell www.twitter.com/_alexjmitchell University of Leicester. www.psycho-oncology.info #ipos2013. …What are the sources of disagreement?. Areas of Disagreement: How to screen (which tool) When to screen

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Alex Mitchell twitter/_alexjmitchell University of Leicester

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  1. Screening for Distress Debate Alex Mitchell www.twitter.com/_alexjmitchell University of Leicester www.psycho-oncology.info #ipos2013

  2. …What are the sources of disagreement?

  3. Areas of Disagreement: How to screen (which tool) When to screen How often to screen Which screening population Who should screen Does screening work

  4. ……in short Should we screen at all?

  5. But what are the alternatives to screening?

  6. Diagnosis as usual (do nothing) Enhanced diagnosis (clinician = screen) Screen everyone Screen high risk (targeted screening)

  7. Comment: Slide illustrates diagnostic accuracy according to score on DT

  8. Lessons from primary care….

  9. Results disappointing Acceptability overlooked Most are not depressed Many do not want help Some are already Rx

  10. Screening in Cancer

  11. Missed diagnosisGP = CNS = Oncologists

  12. Screening tools (validity)

  13. Depression Distress Brief / ultra-short Multi-domain

  14. Implementation evidence Randomized Non-Randomized

  15. Q. What type of studies? Q. How many +ve studies? Q. What are the beneficial outcomes? Q. What is the size of the effect?

  16. Implementation Reviews

  17. Implementation Studies • 9 studies Distress => Referral • 6 studies => Communication

  18. ….this is getting complex……. ………………..what is the overall effect?

  19. Overall Effect of screening Baseline CARE x% with screening +10% (0-20%)

  20. Overall Effect of screening Baseline CARE x% with screening +10% + follow-up +10% +treatment +10%

  21. What is holding back screening success?

  22. BOTH. How Many Receive Ps Help? (n=2557)

  23. % Receiving Any treatment for Mental Health 12mo Service Use (NIH, 2002) Maria Hewitt, Julia H. RowlandMental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey Journal of Clinical Oncology, Vol 20, Issue 23 (December), 2002: 4581-4590

  24. Overall Effect of screening Baseline CARE x = 35% with screening +10% (0-20%) + follow-up +10% (0-20%) +treatment +10% (0-20%)

  25. ……..So is screening successful or not? …….It depends

  26. Analogy: How do we reduce speeding drivers? US deaths 10,000

  27. Analogy Aim is to reduce speed (and hence deaths) Not simply to detect speeding!

  28. Aim is to reduce distress (improving QoL) Not simply to detect distress!

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