PCQN QI Collaborative. Anxiety Screening & Improvement July 25, 2017

Transcription

1 PCQN QI Collaborative Anxiety Screening & Improvement July 25, 2017

2 Agenda Review data PDSA worksheet - updates Case discussions Next steps 7/25/2017 2

3 PCQN Anxiety Data - Inpatient 12/1/2016 7/19/2017 Patients screened for anxiety at time of first symptom assessment

4 % of Patients Screened for Anxiety at First Assessment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% PCQN Anxiety Collaborative 7/25/2017 4

5 PCQN Anxiety Data - Inpatient 12/1/2016 7/19/2017 Patients screened for anxiety at time of first symptom assessment

6 PCQN Anxiety Data - Inpatient 12/1/2016 7/19/2017 Patients screened for anxiety during course of consultation.

7 % of Patients Screened for at least 1x 100% 90% 80% 70% 60% 50% 40% 30% PCQN Anxiety Collaborative 20% 10% 0% 7/25/2017 7

8 PCQN Anxiety Data - Inpatient 12/1/2017 7/19/2017 Patients screened for anxiety during course of consultation.

9 PCQN Anxiety Data - Inpatient 12/1/2016 7/19/207 Improvement from 1 st to 2 nd assessment: 83.6% of patients improved from 1 st to last assessment

10 % Improvement First to Second Assessment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% PCQN Anxiety Collaborative 7/25/

11 PCQN Anxiety Data - Inpatient 12/1/2016 7/19/207 Improvement from 1 st to 2 nd assessment: 83.6% of patients improved from 1 st to last assessment

12 Project Updates 7/25/

13 UCSF Example 7/25/

14 UCSF Example 7/25/

15 Case Discussions 7/25/

16 Non-pharm treatments for anxiety Intervention Summary USPTF Grade Meditation It s unclear if meditation helps with diagnosed B anxiety disorders (grade C for diagnosed anxiety), but in cancer patients meditation seems to help with as few as two sessions. One RCT, n = 90, showed that mindfulness based meditation was effective at decreasing mood disturbance and stress symptoms in cancer outpatients, and benefits were sustained at 6 months. Another trial found that meditation more effective than no meditation for radiation therapy patients. Yoga for anxiety A Cochrane review and another meta-analysis B concluded that yoga is more effective than no treatment for anxiety. Deep breathing exercise Breathing Techniques were shown to reduce anxiety or distress in patients in some studies of palliative care patients, stem cell transplant patients and asthma patients. Guided Imagery Few studies in PC population, however, one small study shows effectiveness for depression but not anxiety C C Technical Notes 2 small trials show strong effect in patients with cancer who have mood disturbance and anxiety symptoms but not diagnosed anxiety. Strong evidence of effectiveness compared to no treatment, but effectiveness compared to other treatments is not clear. Evidence of effectiveness from multiple small studies in different populations, but evidence in palliative care patients is limited. Only one small study shows effectiveness for depression in palliative care patient population. 7/25/

17 Non-pharm treatments for anxiety Intervention Summary USPTF Grade Acupuncture A 2013 review found that there was I insufficient/conflicting evidence to determine the effectiveness of acupuncture for depression/anxiety in cancer patients. No other relevant results were found. Technical Notes Evidence is insufficient/conflicting Craniosacral Therapy Essential Oils Homeopathy No sources found I No evidence found Some small studies show effects of essential oil I aromatherapy and massage in reducing anxiety and depression in hospice patients, perioperatively, during hemodialysis, and in critically ill patients, however the evidence is not strong enough to recommend. Multiple reviews conclude that evidence is I insufficient to make conclusions about the effectiveness of homeopathy for anxiety and depression. Some anecdotal studies, and nonblinded studies show benefit, but few RCTs that are underpowered are insufficient evidence. Insufficient evidence to recommend, but preliminary results suggest possible effectiveness. Evidence is insufficient/conflicting 7/25/

18 Non-pharm treatments for anxiety Intervention Summary USPTF Grade Cognitive Level I evidence (at least 2 RCTs) showed A Behavioral efficacy of CBT for depressive symptoms in Therapy (CBT) chemotherapy and metastatic cancer patients, and at least one trial showed efficacy for major depressive disorder. CBT was also found to be effective for depressive symptoms in at least 1 RCT for radiotherapy and post-treatment Counseling/psyc hotherapy cancer pts. A 2006 review found 2 RCTs that show counseling/psychotherapy is effective for depressive symptoms in cancer patients and notes one study that found it effective for major depression and others that did not. Support Groups Generally have been found to reduce depressive symptoms in multiple RCTs, although there are some negative results. B/C B Technical Notes Strong evidence of efficacy from multiple trials for treating depression in cancer patients undergoing chemotherapy and radiation therapy. Several smaller studies show effectiveness for depressive symptoms but evidence for major depression is insufficient/conflicting 7/25/

19 Non-pharm treatments for anxiety Intervention Summary USPTF Grade Yoga for A 2010 review found a variety of studies C depression showing that yoga interventions reduced depressive symptoms in patients with major depressive disorder (not geriatric or palliative care patients). A meta-analysis in a questionably reputable journal of two trials (n total = 140) found yoga to be more effective than a placebo at reducing depressive symptoms in cancer patients. An interesting note about yoga several papers report that even when yoga was not found to improve anxiety or depression symptoms patients still self-reported improvement. One study found that there were social and quality of life benefits to participating in yoga for breast cancer patients, especially if not receiving chemotherapy (n = 120). Technical Notes Yoga has been found to be effective for major depressive disorder, however not in palliative care patients, and evidence in palliative patients is not high quality. 7/25/

20 Pledges! What is one thing you can try in the next week to help you better understand or improve your patients anxiety?

21 Thank you! See you on the next QI collaborative call: August 29 at 12:00pm PST Kara Bischoff: Angela Marks: Rachel Stone: 7/25/