Guiding Lay Navigation in Geriatric Patients With Cancer Using a Distress Assessment Tool

Authors:
Gabrielle B. Rocque From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Richard A. Taylor From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Aras Acemgil From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Xuelin Li From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Maria Pisu From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Kelly Kenzik From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Bradford E. Jackson From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Karina I. Halilova From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Wendy Demark-Wahnefried From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Karen Meneses From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Yufeng Li From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Michelle Y. Martin From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Carol Chambless From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Nedra Lisovicz From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Mona Fouad From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Edward E. Partridge From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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Elizabeth A. Kvale From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.
From University of Alabama at Birmingham Comprehensive Cancer Center; Divisions of Hematology and Oncology and Preventive Medicine, University of Alabama at Birmingham School of Medicine; University of Alabama at Birmingham School of Nursing; and Birmingham VA Medical Center, Birmingham, Alabama.

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the Patient Care Connect Group
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Background: There is growing interest in psychosocial care and evaluating distress in patients with cancer. As of 2015, the Commission on Cancer requires cancer centers to screen patients for distress, but the optimal approach to implementation remains unclear. Methods: We assessed the feasibility and impact of using distress assessments to frame lay navigator interactions with geriatric patients with cancer who were enrolled in navigation between January 1, 2014, and December 31, 2014. Results: Of the 5,121 patients enrolled in our lay patient navigation program, 4,520 (88%) completed at least one assessment using a standardized distress tool (DT). Navigators used the tool to structure both formal and informal distress assessments. Of all patients, 24% reported distress scores of 4 or greater and 5.5% reported distress scores of 8 or greater. The most common sources of distress at initial assessment were pain, balance/mobility difficulties, and fatigue. Minority patients reported similar sources of distress as the overall program population, with increased relative distress related to logistical issues, such as transportation and financial/insurance questions. Patients were more likely to ask for help with questions about insurance/financial needs (79%), transportation (76%), and knowledge deficits about diet/nutrition (76%) and diagnosis (66%) when these items contributed to distress. Conclusions: Lay navigators were able to routinely screen for patient distress at a high degree of penetration using a structured distress assessment.

To view members of the Patient Care Connect Group, see supplemental eAppendix 1, available with this issue, at JNCCN.org.

Correspondence: Gabrielle B. Rocque, MD, University of Alabama School of Medicine, 1824 6th Avenue South, WTI 240E, Birmingham, AL 35294-3300. E-mail: grocque@uabmc.edu

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