Acceptability and service integration of a co-designed evidence-informed distress screening and referral model in Australian cancer information and support telephone services.

Abstract

Many telephone-based Cancer Information and Support services (CIS) use distress screening tools. However, screening-based referral and repeat screening are less common. The Structured Triage And Referral by Telephone (START) trial implemented an evidence-informed co-designed model of structured-care. This study explored acceptability and integration of structured care into Australian Cancer Council telephone-based support services. The START model for patient and caregiver callers supplemented existing Distress Thermometer (DT) use with Patient Health Questionnaire-4 (PHQ-4) screening, a structured referral pathway, and an outbound follow-up call with re-screening. Acceptability and integration of the model were assessed between April 2017 and March 2020 using interviews with Cancer Council consultants and analysis of call recordings. Analysis of 11 interviews identified seven themes relating to advantages and disadvantages of the START model. Perceived advantages were: clear framework to initiate discussion about distress; enhanced consultant confidence and understanding managing distress; and outbound calls providing continuity of care. Perceived disadvantages were: concerns about screening; necessity of screening; challenges introducing screening appropriateness for some callers; and workload. Staff reported satisfaction with the model becoming routine practice. Assessment of 107 call recordings found similar call length between usual care and START. The PHQ-4 was administered in 91.5% of START calls with some variation to standardised delivery and a significant increase in outbound calls relative to usual care (59.3% v 31.3%, p = 0.004). The systematic implementation of evidence-informed structured care protocols in CIS services is seen as acceptable and beneficial to service staff and callers. Further assessment is required to assess long-term integration of the model into care. Introducing structured care represented significant changes to caller-driven practices. Ongoing monitoring and further evaluation are required for consistent implementation and to assess how variations in implementation affect caller experience and outcomes.