Introduction of Distress Thermometer (DT) Screening in the US Community Oncology Setting: A Retrospective Study of Electronic Health Records (EHR) Integration
Author(s)
Kat M. Aguilar, MPH1, Divea Venkatasetty, MPH1, Janet Espirito, PharmD1, Chuck Wentworth, MS1, Zhaohui Su, PhD1, Gregory Patton, MD1, Lydia Mills, MSW, LCSW, LICSW2, Biswajit Brahma, DSCS1, Jessica K. Paulus, ScD1;
1Ontada, Boston, MA, USA, 2McKesson, The Woodlands, TX, USA
1Ontada, Boston, MA, USA, 2McKesson, The Woodlands, TX, USA
OBJECTIVES: The DT is a well-validated instrument for screening psychological distress and health-related social concerns among patients with cancer and other chronic conditions. Integrating the DT into EHRs may facilitate providers’ ability to address these health determinants as part of routine care, improving outcomes and quality of life. This study evaluated DT utilization following EHR implementation in 2023 across a large network of US community oncology clinics.
METHODS: This was a retrospective, observational study of patients treated within The US Oncology Network following integration of the DT into the iKnowMed EHR. Adult patients with cancer who visited a clinic between 7/1/2023-11/30/24 were classified as having or lacking DT screening during this period. Patterns of DT utilization were assessed descriptively.
RESULTS: Among 235,761 eligible patients, 29,062 (12%) completed DT screening in the EHR and 206,699 (88%) did not, including 2,704 who declined. EHR documentation of DT screening rates were 16% (n=9,232) and 11% (n=19,830) for patients with (n=57,234) and without metastases (n=178,527), respectively. Clinically elevated initial distress (score≥4) was observed in 23% (n=6,698) overall, as well as in 28% (n=2,601) and 21% (n=4,097) of those with and without metastases, respectively. Overall, physical concerns were most frequently reported (45%; n=12,963), followed by emotional (33%; n=9,551) and practical concerns (25%; n=7,248). Among patients with multiple screenings, improved distress at follow-up was observed among 17% (n=1,747) and 66% (n=1,989) of those with an initial DT score of <4 and ≥4, respectively.
CONCLUSIONS: In this community oncology population, approximately one in four patients reported elevated distress, underscoring psychosocial screening’s importance in clinical practice. Although utilization of the DT in the EHR was limited during this early phase of integration, patients with multiple screenings often reported improvements, especially those with elevated distress. Further investigation should examine how DT integration into an EHR may influence intermediate- and long-term patient outcomes.
METHODS: This was a retrospective, observational study of patients treated within The US Oncology Network following integration of the DT into the iKnowMed EHR. Adult patients with cancer who visited a clinic between 7/1/2023-11/30/24 were classified as having or lacking DT screening during this period. Patterns of DT utilization were assessed descriptively.
RESULTS: Among 235,761 eligible patients, 29,062 (12%) completed DT screening in the EHR and 206,699 (88%) did not, including 2,704 who declined. EHR documentation of DT screening rates were 16% (n=9,232) and 11% (n=19,830) for patients with (n=57,234) and without metastases (n=178,527), respectively. Clinically elevated initial distress (score≥4) was observed in 23% (n=6,698) overall, as well as in 28% (n=2,601) and 21% (n=4,097) of those with and without metastases, respectively. Overall, physical concerns were most frequently reported (45%; n=12,963), followed by emotional (33%; n=9,551) and practical concerns (25%; n=7,248). Among patients with multiple screenings, improved distress at follow-up was observed among 17% (n=1,747) and 66% (n=1,989) of those with an initial DT score of <4 and ≥4, respectively.
CONCLUSIONS: In this community oncology population, approximately one in four patients reported elevated distress, underscoring psychosocial screening’s importance in clinical practice. Although utilization of the DT in the EHR was limited during this early phase of integration, patients with multiple screenings often reported improvements, especially those with elevated distress. Further investigation should examine how DT integration into an EHR may influence intermediate- and long-term patient outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P33
Topic
Patient-Centered Research
Topic Subcategory
Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Mental Health (including addition), SDC: Oncology