Value of structural psychosocial screening in improving
quality of life and satisfaction with care received in patients with lung
cancer. The "care" study.

Lung cancer is the most lethal of cancers in the western world today, and its
incidence still increases. Most patients with lung cancer present with an
advanced disease state, which is usually incurable. Aggressive treatment has
not improved the five-year survival noticeably the past decades. The diagnosis
lung cancer has a massive impact on patients resulting in a high percentage
psychosocial distress (reported in up to 51% of patients). In usaul medical
care less than 10% of these patients recieve psychosocial care.
Thus, screening patients with cancer to detect psychosocial problems has often
been advocated to aid the conversation between patient and medical specialist
and/or achieve appropriate referrals to other health care givers. Clinical
assessment of psychosocial problems is perceived to be time consuming, a bottle
neck in busy outpatient clinics. Therefore, use of a short screening instrument
completed by the patient would be opportune. This instrument should be
self-administered, be cancer-specific, be sensitive to change over time, be
easy to interpret, give insight into different quality of life domains, have
acceptable validity and reliability, identify patients at risk and give an
indication for referral. In the Netherlands a revised version of the Distress
Thermometer and Problem (DTP) list has recently been validated for identifying
patients at risk. In addition, the DTP list has been chosen as the preferred
instrument in the Dutch guideline on detection of psychosocial care needs in
cancer patients. The process of psychosocial screening should involve three
components: completion of a screening instrument, communication about the
response pattern (severity and nature of problems) and referral if needed and
desired by the patient.
The DTP list has not been validated prospectively in such a treatment algorithm
yet.
Psychosocial screening should result in an improvement in the quality of care
provided and in improved patients* satisfaction
with care. Still, in the short term implementation requires dedication of
additional resources that will initially result in extra costs. However, we
hypothesize that when all costs are taken into account the net result will be a
reduction in costs e.g. due to less medical consumption.

The aim is to examine whether care and treatment guided by structural
psychosocial screening leads to a better quality of life and greater patient
satisfaction than usual care alone in patients with lung cancer.

The study has a randomized controlled, parallel design with 250 participating
patients assigned to either the
standard care or the experimental group. Patients in the experimental group
only will receive care guided by repeated psychosocial screening with the Dutch
distress thermometer and problem list on top of usual care.
Months 1-5 startup, 5-29 patient inclusion, 29-48 follow up statistical
analyses and reporting.

Dutch distress thermometer and problem list guided psychosocial care

estimated extra time spent aproximately two hours for patients in the control
(four times half an hour for filling in the questionnaires) and two hours for
patients in the experimental group. No additional risks are expected.