Recognizing Adolescent and Young Adult Cancer Patient Mental Health: Utilizing the AYA-POST to Improve Distress and Access to Psychosocial Care

BACKGROUND: Distress and psychosocial problems are prevalent among adolescent and young adult (AYA) cancer patients, yet there is a lack of psychosocial support available during treatment. Several risk factors affect this population’s quality of life, including psychosocial functioning. Screening for distress and psychosocial problems during follow-up visits may result in earlier detection and treatment, as well as improved communication between providers and patients.

LOCAL PROBLEM: The setting of this practice improvement project was an oncology clinic in the southeastern United States, serving children and AYAs. No process exists for screening for distress and psychosocial problems at the site. The purpose of the project is to implement a screening process for distress and psychosocial problems during AYAs' follow-up appointments. The project aims to screen 80% of AYAs at their follow-up appointments. Of those who receive a referral to psychosocial support, 50% will schedule an orientation session at the psychosocial support center.

METHODS: The Johns Hopkins Evidence-Based Practice (JHEBP) model provided a framework for project implementation. The clinical workflow for administering the Adolescent and Young Adult Psycho-Oncology Screening tool (AYA-POST) was refined through PDSA (Plan-Do-Study-Act) cycles. Implementation data was measured to evaluate screening rates and process compliance.

INTERVENTIONS: The AYA-POST was offered in English and Spanish and administered to AYAs aged 15-39 at every follow-up appointment while awaiting provider consultation.

RESULTS: The screener was administered in 47.4% of follow-up appointments, and 91.7% of the follow-up appointments met referral criteria to the psychosocial center. 100% of appointments meeting criteria for a psychosocial referral were set up for an orientation session.

CONCLUSIONS: Implementing the AYA-POST during follow-up appointments had a clinically significant impact by helping identify significant distress and psychosocial concerns so they could be addressed, thereby increasing access to psychosocial support. Sustainability plans include continuing to use the AYA-POST at appointments and considering expanding its use to the inpatient unit.