Women With Gynecologic Cancers: Screening for Substance Use Disorders Is Key

Substance use disorders (SUDs) among women with gynecologic cancers pose challenges to treatment adherence, patient well-being, morbidity, and mortality. Despite the prevalence of SUDs, routine screening practices have not been widely adopted. This quality improvement project implemented the Revised Opioid Risk Tool (ORT-OUD) to screen for SUDs among gynecologic oncology patients. The aims were to provide a referral to addiction psychiatry in a minimum of 80% of patients who screened as high risk and demonstrate the feasibility of ORT-OUD implementation in clinical practice, with at least 75% of advanced practice providers (APPs) reporting it as feasible. The ORT-OUD was offered to all patients aged 18 years or older, consented, and were on the APPs' schedules during the project implementation period (3 months). Patients completed the ORT-OUD privately, and APPs reviewed and scored the tool. Patients with scores of 3 or higher were offered a referral to addiction psychiatry. Advanced practice providers were then given a survey to assess their perception of the project's feasibility. Descriptive statistics were used to track referral rates and APP perceptions. Of 134 patients screened, 9.7% were identified as high risk for SUDs. Of those patients, 76.9% accepted a referral to addiction psychiatry. One hundred percent of APPs reported the ORT-OUD implementation as feasible. Challenges identified included time needed to explain the screening tool and patients' perceptions of the screening tool questions. This project successfully identified a proportion of gynecologic oncology patients at risk for SUDs and facilitated access to specialized care. Challenges in the screening process highlight the importance of patient education and communication strategies.