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Predictive Factors Associated with Declining Psycho-Oncological Support in Patients with Cancer.

Karoline Hecht1, Moritz Philipp Günther1, Johannes Kirchebner2

  • 1Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091 Zürich, Switzerland.

Current Oncology (Toronto, Ont.)
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Summary

Nurses effectively screen cancer patients for psycho-oncological support needs. Older patients, those with lower distress, and fewer health issues are more likely to decline support, indicating a need for improved patient education.

Keywords:
distress in oncological patientsdistress screeningmachine learningrejecting psycho-oncological support

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Area of Science:

  • Oncology
  • Psycho-oncology
  • Health Services Research

Background:

  • International guidelines advocate for routine distress screening by nurses to facilitate psycho-oncological support for cancer patients.
  • The distress thermometer and problem list are commonly used tools for identifying patients needing psychosocial support.
  • Understanding factors associated with declining support is crucial for optimizing screening efficiency.

Purpose of the Study:

  • To identify predictors of patients declining psycho-oncological support using machine learning.
  • To enhance the efficiency of nurses in screening for psycho-oncological support needs in oncology settings.
  • To inform targeted interventions for patients who may benefit from but refuse support.

Main Methods:

  • Machine learning analysis of routinely collected clinical data from 4064 cancer patients.
  • Cross-validation and nested resampling techniques were employed to ensure model robustness and prevent overfitting.
  • Predictive modeling was used to identify characteristics of patients who refused psycho-oncological support.

Main Results:

  • The developed machine learning model achieved 89% sensitivity and 68.5% accuracy in detecting patients who decline support (AUC 79%).
  • Key predictors for declining support included older age, lower distress thermometer scores, fewer comorbidities, and fewer reported physical problems.
  • Patients reporting less sadness, fear, or worry were also more likely to refuse support.

Conclusions:

  • Current distress screening procedures are valuable for daily nursing practice in oncology.
  • Nurses may require additional training and time to address patient misconceptions about psycho-oncological support.
  • Refining screening protocols can improve the identification and acceptance of psychosocial care among cancer patients.