KCCC NPs screen patients at their initial and subsequent visits using a one-page screening tool to detect depression, pain, fatigue, and other problems. If the patient answers yes to either of the first two questions (a two-question depression screening tool), the Patient Health Questionnaire-9 (PHQ-9) screening tool for depression is administered to help determine whether the patient is in fact experiencing depression. Positive findings are addressed using a treatment algorithm standardized across clinical sites (Adkins et al., 2005).8 If an intervention is established, the NP documents it in a note that the physician reviews so as to be able to follow up on the symptoms. The patient may also have a follow-up visit with the NP. NPs and physicians often alternate seeing patients in order to assess the physical, psychosocial, and spiritual needs of patients.

Based on the results of the screen and periodic psychosocial assessments, KCCC nurses link patients with multiple psychosocial services available in the Kansas City area. Cancer Action, for example, is a community-based nonprofit agency in Kansas City offering an array of programs and services that address the physical, social, emotional, financial, and spiritual needs of people with cancer and their families and friends. All Cancer Action programs and services are free of charge (see http://www.canceractionkc.org). For patients who are uninsured or underinsured, Swope Parkway Health Center, Catholic Charities, the Alliance for the Mentally Ill of Greater Kansas City, Samuel Rodgers Health Center, and Kansas City Free Health Clinic offer mental health counseling either free of charge or on a sliding scale. KCCC also has partnered with Metro CARE, WyJoCARE, and Northland CARE, organizations of specialists that have agreed to take a limited number of uninsured patients. For patients who are working, many employers have employee assistance programs that offer counseling free of charge. If the employees need further counseling, KCCC refers them to a counselor for continuation of care. If there is no employee assistance program where patients work, they are referred based on their insurance.

KCCC also partners with Turning Point: The Center for Hope and Healing, a 5-year-old 501c3 organization whose mission is to strengthen resilience in individuals living with cancer or other serious or chronic illnesses by providing education and other tools to help them manage their illness and live life to its fullest. Turning Point served approximately 3,400 people in the Kansas City area in 2006; approximately 85 percent of these were cancer patients, 55 percent of whom were referred by KCCC. The more than 50 different education and support programs provided by Turning Point to adults, children, families, and friends include counseling; exercise classes; nutrition classes; and specialized classes such as Surviving

8

KCCC partnered with the Mid America Coalition for Health Care to create the treatment algorithm. The coalition also recommended the use of the PHQ-9 tool.



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