Patient education and counseling · 2026
Acceptability and service integration of a co-designed evidence-informed distress screening and referral model in Australian cancer information and support telephone services.
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Fradgley Elizabeth A, Lane Katherine, Priaulx Jan, Byrnes Emma, Morris Sarah B, Taylor Jo, Bridge Paula, Boyes Allison, Boltong Anna, Clinton-McHarg Tara, Paul Christine L
Аннотация
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
IMPLICATIONS FOR PRACTICE: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
IMPLICATIONS FOR PRACTICE: 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.