Abstract
BACKGROUND: Background: Patients diagnosed with high-grade gliomas (HGG) often experience significant distress. However, due to neurological/neurocognitive deficits its assessment remains challenging. We evaluated face-to-face assessment during doctor-patient consultations (DPC) regarding impact on referral to psychosocial services and the effects of DPC on patients’ emotional well-being. METHODS: In this multicenter, two-arm cluster-randomized study involving 13 centers, distress was screened in the intervention group (IG) by three screening questions (SQ) during the DPC versus via questionnaire (Distress Thermometer) in the control group (CG). Of key interest was the proportion of patients with poor emotional functioning (as measured by the EORTC Quality of Life Questionnaire) who received specialized psychosocial care (PC). The effect of SQ vs. screening by questionnaire was evaluated regarding patients’ wellbeing and economic factors. We were also interested in whether the number of SQ with positive answers (regarding deterioration or burden of the disease) was related to emotional functioning (EF, according to EORTC QLQ C30). Poor EF was defined with the threshold of ≤71 (score 0-100, lower score indicates lower functioning). Utilization of PC was measured at follow-up. Analysis employed mixed models logistic regression. RESULTS: In total, 763 patients were enrolled at baseline, and 506 completed the follow-up. Emotional functioning was poor in 59.7%, both in the IG (168/281) and in the KG (134/225). The frequency of patients reporting PC utilization was comparable between the groups (IG 93/168, 55.4% vs. CG 87/134, 64.9%, odds ratio (OR)=0.67, 95% confidence interval (CI)=0.40-1.11, p=0.115). The DPC in both groups was similar in length (IG 15-26 min, mean=23.06 min, SD=9.16 vs. CG 12-35, mean=23.04 min, SD=14.63). The majority of the patients (71%) felt relieved after the consultation without significant difference between IG and CG (fisher’s exact test, p=0.322). The answers to the SQ (IG) were related to EF: The more SQ were answered with “yes” (regarding deterioration/burden), the worse EF was (None SQ positive (n=39): median EF=91.7; 1 SQ positive (n=70): median EF 75.0; 2 SQ positive (n=113): median EF 58.3; 3 SQ positive (n=121): median EF 50.0). CONCLUSION: Screening for distress in patients with HGG through DPC results in a referral to psychosocial services comparable to screening by questionnaires. This approach involves important stakeholders - patients and physicians - in a very direct manner. If the SQ would be applied in clinical routine, a clinically relevant burden should be considered if at least one question is answered in the affirmative (deterioration or burden present).