Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Lam HM(1), Chong SC(2), Wan YM(1), Fong SK(1), Lau SMJ(1)
Affiliation :
(1)Department of Medicine, Queen Elizabeth Hospital (2)Department of Clinical Psychology, Queen Elizabeth Hospital
Introduction :
Patients with hematologic malignancies have a higher rate of suicide completion than noncancer population. Experiencing depression and distress during treatment is common and is associated with receiving intensive treatment such as chemotherapy. Distress level varies at different time points of the treatment journey, e.g. break bad news, relapse and disease progression. Therefore, it is important to assess psychological symptoms throughout the illness journey.
Objectives :
1.Identify patients at high risk of committing suicide. 2.Implement effective intervention to reduce the distress level and enable effective prevention of suicide attempts.
Methodology :
Cases were seen by cancer case manager or haematologists and were assessed either clinically and/or with screening tools at different time points of treatment as needed. There are three levels of screening. Level 1: NCCN Distress Thermometer (DT) (both inpatient & outpatient) Level; 2: General Anxiety Disorder-7 and Patient Health Questionaire-9 (PHQ-9) for anxiety and depression screening (outpatient only) if DT>4/10; Level 3: Suicide risk screening (ASQ)for emotional inpatient or outpatient case if Q9>0 in PHQ-9
Result & Outcome :
From Jan 2022 to Dec 2023, 200 cases under Cancer Case Management (CCM) program were assessed at different time points of treatment followed by clinical assessment during medical or CCM consultation. 8 cases (8/200) with unstable emotion were clinically identified by CCM or haematologists. All of the 8 cases (100%) had score above 4/10 in DT. Four cases (4/8; 50%) had suicidal ideation and the other 4 denied suicidal ideation. 6/8 were referred for psychiatric or clinical psychology assessment. All patients showed a decrease in distress level in follow up review. For those patients not clinically identified to have unstable emotion, 39 patients (39/200) scored 8-10/10 in DT. Two cases (2/39; 5%) had suicidal ideation and were referred for psychiatric and clinical psychology assessment. They showed significant decrease in score after follow up review. In this local hospital cohort, clinical assessment and screening tools were effective in early detection of patients with high risk of committing suicide. Early evaluation and screening for distress significantly reduce the distress level with effective interventions. There was no episode of committing suicide among the six cases with suicidal ideation.
