scholarly journals A Role for Cancer Nurses: Responding to Distress in Cancer Patients

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Margaret Fitch ◽  
Deborah McLeod ◽  
Doris Howell ◽  
Esther Green
Keyword(s):  
Cancer Patients ◽  
Program Implementation ◽  
Care Patient ◽  
Distress Screening ◽  
Guidelines Implementation ◽  
Continuous Quality ◽  
Quality Cancer Care ◽  
Screening For Distress ◽  
Cancer Nurses ◽  
Patient Concerns

Background: Although all patients experience distress, between 35-45% experience clinically significant levels of distress such as anxiety, depression and adjustment difficulties. Early identification of distress and the provision of relevant interventions is a standard of quality cancer care. Nurses have a critically important role in identifying individuals with distress and providing interventions to manage distress.Objectives: Our objectives are to define the role of cancer nurses in responding to emotional distress experienced by cancer patients and to document the best practices for implementing a program of screening for distress in ambulatory settings.Methods: A programmatic approach to screening for distress (6th vital sign) has been implemented in several cancer facilities across Canada. The program includes protocols for screening, algorithms for assessment, and guidelines for evidenced based interventions. Introduction of the programs have included relevant education of nurses and close attention to uptake and utilization of practice guidelines. Implementation has been mounted within the context of continuous quality improvement and the use of rapid cycle evaluation.Results: Evaluation of successful program implementation has shown increased patient satisfaction with care. Patient concerns provide the focus for opening conversations with individuals and the basis for planning person-centered approaches to care. Patient concerns are identified through the screening maneuver beyond those related to tumor and side effect management. Nurses are in an excellent position to respond to scores on a standardized distress screening tool as part of their patient assessments. The assessments provide a foundation for individualized or tailored interventions.Conclusions: Using a concrete programmatic approach, including screening, focused evidence-based assessment and interventions, offers benefits in achieving person-centered care for cancer patients. In busy clinical settings, an intentional effort is needed to implement a programmatic approach to screening followed by appropriate assessment and intervention.

Screening for distress

2017 ◽  
Author(s):  
Barry D. Bultz ◽  
Paul B. Jacobsen ◽  
Matthew Loscalzo
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Routine Practice ◽  
Clinical Team ◽  
Accreditation Standard ◽  
The World ◽  
Screening For Distress ◽  
The Right ◽  
Standardized Screening ◽  
Patient Concerns

The prevalence of multifactoral distress is significant for cancer patients. In busy and highly specialized tumour clinics, screening for distress brings the science of caring to the team and enhances the role psychosocial oncology plays in the cancer centre. Standardized screening for distress is a simple and effective tool that can help the clinical team better understand, communicate, address patient concerns, and refer to the right professional in a timely way. Screening for distress has been widely endorsed and has become an accreditation standard in many jurisdictions around the world. Modern cancer care must incorporate screening for distress as routine practice in care of the patient.

scholarly journals From Distress Screening to Uptake: An Italian Multicenter Study of Cancer Patients

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3761
Author(s):  
Elena Meggiolaro ◽  
Silvia De Padova ◽  
Federica Ruffilli ◽  
Tatiana Bertelli ◽  
Marina Bragagni ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Telephone Interview ◽  
Psychological Intervention ◽  
Supportive Services ◽  
Distress Screening ◽  
Potential Barriers ◽  
Physical Problems ◽  
Practical Usefulness ◽  
Per Se ◽  
Opening Up

Introduction: Little consideration is given to the referral and uptake of available supportive services after distress screening. However, identifying the reasons for accepting or refusing help is mandatory for implementing a screening policy. The present study explored the practical usefulness of and potential barriers to the application of distress management. Methods: 406 cancer patients were consecutively selected and asked to complete the Distress Thermometer (DT) and Problem Check List (PL). All patients with a DT score ≥6 were invited for a post-DT telephone interview with a trained psychologist. Results: The 112 patients who refused to take part were more often older, retired, at a more advanced stage of illness, and with no previous experience of psychological intervention with respect to those who accepted. Of the 78 patients with a score ≥6 who were referred to the Psycho-Oncology Service, 65.4% accepted the telephone interview. Twenty-two patients rejected the initial invitation immediately for various reasons including logistic difficulties, physical problems, and feeling embarrassed about opening up to a psychologist. Conclusions: Our study confirms that screening per sé is insufficient to deal with the problem of distress and that more emphasis should be placed on implementing referral and treatment.

scholarly journals Distress and Resilience in Resettled Refugees of War: Implications for Screening

2021 ◽  
Vol 18 (3) ◽  
pp. 1238
Author(s):  
Michael Hollifield ◽  
Eric C. Toolson ◽  
Sasha Verbillis-Kolp ◽  
Beth Farmer ◽  
Junko Yamazaki ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Self Efficacy ◽  
Strong Predictor ◽  
Significant Loss ◽  
Distress Screening ◽  
Screening For Distress ◽  
Regression Techniques ◽  
High Distress ◽  
Migration Stress ◽  
Domestic Medical

There is little work published about predictors of specific trajectory types of distress in refugees of war during early resettlement in a host country. Data about distress (Refugee Health Screener—15 (RHS-15)) and possible predictors of distress were collected at the domestic medical examination (T1) within 90 days of arrival and the civil surgeon examination (T2) 11–16 months after T1 for refugee groups from three countries (COU). Descriptive, correlative, analyses of variance, and regression techniques were used to determine trajectory type and their predictors. A higher percentage (7.3%) were distressed at T2 than at T1. By group, the Bhutanese became more distressed, the Burmese became less distressed, and Iraqi’s continued to have high distress. A regression model showed gender, loss, post-migration stress, and self-efficacy to be significant predictors of trajectory type (R2 = 0.46). When the T1 RHS-15 score was added to the model, observed variance increased (R2 = 0.53) and T1 RHS score accounted for the majority of variance (r = 0.64, p < 0.001), with post-migration stress accounting for markedly less (β = 0.19, p = 0.03). Loss and self-efficacy became less significant. Loss was, however, a strong predictor of delayed and chronic distress trajectory type. These data suggest that screening for distress should occur at least twice during resettlement to detect those with initial distress and those with delayed distress. Screening should be coupled with identifying other social determinants of health and a comprehensive assessment to determine the need for intervention for secondary prevention (i.e., reducing delayed distress) and treatment (reducing chronic distress).

Distress Screening in Head and Neck Cancer Patients Planned for Cancer‐Directed Radiotherapy

2021 ◽  
Author(s):  
Shirley Lewis ◽  
Saket Pandey ◽  
Naveen Salins ◽  
Jayita Deodhar ◽  
Vijay Patil ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Distress Screening

scholarly journals CancerSupportSource®: validation of a revised multi-dimensional distress screening program for cancer patients and survivors

2019 ◽  
Vol 28 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Joanne S. Buzaglo ◽  
Alexandra K. Zaleta ◽  
Shauna McManus ◽  
Mitch Golant ◽  
Melissa F. Miller
Keyword(s):  
Cancer Patients ◽  
Screening Program ◽  
Distress Screening

scholarly journals Effects on patient-reported outcomes of “Screening of Distress and Referral Need” implemented in Dutch oncology practice

2019 ◽  
Vol 28 (7) ◽  
pp. 3391-3398
Author(s):  
Floor M. van Nuenen ◽  
Stacey M. Donofrio ◽  
Marrit A. Tuinman ◽  
Harry B. M. van de Wiel ◽  
Josette E. H. M. Hoekstra-Weebers
Keyword(s):  
Patient Reported Outcomes ◽  
Distress Screening ◽  
Social And Emotional ◽  
Distress Level ◽  
Patient Reported ◽  
Specialized Care ◽  
Eortc Qlq C30 ◽  
Screening For Distress ◽  
Oncology Practice ◽  
Eortc Qlq

Abstract Purpose This study investigated the effect of the “Screening for Distress and Referral Need” (SDRN) process (completing a screening instrument; patient-caregiver discussion about the patient’s responses, regardless of distress level, and possible referral to specialized care), implemented in Dutch oncology practice on patient-reported outcomes (PROs). Methods A non-randomized time-sequential study was conducted to compare two cohorts. Cohort 1 respondents (C1) were recruited before and cohort 2 respondents (C2) after SDRN implementation in nine Dutch hospitals. Participants completed the EORTC-QLQ-C30, HADS, Patient Satisfaction Questionnaire-III, and the Distress Thermometer and Problem List (DT&PL). Descriptive analyses and univariate tests were conducted. Results C2 respondents (N = 422, response = 54%) had significantly lower mean scores on the practical (t = 2.3; p = 0.02), social (t = 2.3; p = 0.03), and emotional PL domains (t = 2.9; p = 0.004) compared with C1 (N = 518, response = 53%). No significant differences were found on quality of life, anxiety, depression, satisfaction with care, distress level, the spiritual and physical PL domains, or on referral wish. Conclusions After implementation of SDRN, patients report significantly fewer psychosocial (practical, social, and emotional) problems on the DT/PL but responses on the other patient-reported outcomes were comparable. These results add to the mixed evidence on the beneficial effect of distress screening. More and better focused research is needed.

The Commission on Cancer Psychosocial Distress Screening Standard: The first year in review.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 198-198 ◽  
Author(s):  
Nina S. Miller ◽  
Ryan M. McCabe ◽  
Allison Knutson
Keyword(s):  
Cancer Patients ◽  
Treatment Plan ◽  
Psychosocial Care ◽  
Psychosocial Distress ◽  
Screening Tools ◽  
Institute Of Medicine ◽  
Distress Screening ◽  
Patient Centered ◽  
Screening Process ◽  
Cancer Program

198 Background: In response to recommendations from the 2007 Institute of Medicine report, Cancer Care for the Whole Patient, the American College of Surgeons’ Commission on Cancer developed a set of Continuum of Care standards, including a patient-centered standard regarding the delivery of psychosocial distress screening to all cancer patients. According to Cancer Program Standards 2012: Ensuring Patient-Centered Care, the accredited cancer program must implement a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care. Patients experience psychological, social, financial, and behavioral issues that can interfere with their treatment plan and adversely affect outcomes. Screening processes result in the identification of distressed cancer patients and assessment and referral pathways to ensure appropriate psychosocial care provision can be obtained. The standard was established in 2012 with a 2015 implementation period allowing programs time to develop a screening, assessment, and referral process tailored to their patient population. Methods: Programs submit documentation to describe their process for delivery of care through an electronic activity report. Documentation of this standard includes the timing for delivery of the psychosocial distress screening tool; methodology; the specific tools selected with preference to validated and reliable screening tools; and a process for assessment, referral and documentation. This presentation will summarize the program submissions for 2015 and include an analysis of the details of the standard compliance as reported by accredited programs. Results: This analysis will include responses from all Commission on Cancer accredited programs reporting on this standard. The analysis will provide information about the trends in the timing, methods, and tools used by programs implementing a psychosocial distress screening process. Conclusions: This analysis will inform future decisions about standardization of a screening process and the feasibility of pooling data across centers.

Psychosocial distress screening in cancer care.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 187-187 ◽  
Author(s):  
N Mullai
Keyword(s):  
Cancer Patients ◽  
Cancer Care ◽  
Trigger Point ◽  
Emotional Experience ◽  
Psychosocial Care ◽  
Specific Area ◽  
Psychosocial Distress ◽  
Medical Visit ◽  
Distress Screening ◽  
Distress Level

187 Background: Distress is a multifactorial, emotional experience that may interfere with patients’ ability to cope with cancer and its treatment. Recognizing and managing distress may benefit patients. The Commission on Cancer requires implementation of Standard 3.2, Psychosocial Distress Screening in 2015 and integrating distress intervention in cancer care. This study evaluates patients’ perception on benefits in this regard. Methods: Patients were screened at least once at a pivotal medical visit using a questionnaire that included various aspects of stress. NCCN’s Psychosocial Distress Screening Tool was used to measure seriousness of distress. Patients marked their distress level on a scale of 1 to 10. A threshold of 5 was set as a trigger point to start addressing distress. Results: Answers from 311 cancer patients (male 61%; female 39%) were evaluated since January 2015. A majority of patients had breast cancer (29%), followed by lung (18%), GI (18%), and hematological (12%) malignancies. The mean distress score was 3.72 (male 3.14; female 3.97). 131 patients had a score above five. Age group, 40-49 years had a higher distress (4.79) compared to others. Esophageal cancer (1%) had the highest mean score 7.33 followed by head & neck cancer (4%) with 5.67. In most patients, anxiety about cancer and its treatment was the cause of distress. However, they did not want any additional psychosocial intervention except for talking to their oncologist and primary physician. The distress of some patients was family related and they were unsure of the help needed. Two patients refused screening stating the questions were intrusive. Conclusions: Coordinated psychosocial care may benefit cancer patients with significant distress. NCCN tool helps to assess the severity of patients’ distress and to determine the need for intervention. The results (mean score of 3.72) suggest most cancer patients need no major intervention or special psychosocial counseling other than discussing with their physician and family, which is done routinely in most oncology practices. However, when stress is expressed, this tool does help the treating physicians to determine the specific area and degree of stress, to focus on the type of help needed for the patient, and to channel resources appropriately.

Comprehensive distress screening and referral at a tertiary cancer center.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 134-134
Author(s):  
Elizabeth Trice Loggers ◽  
Stephen Duane Watkins King ◽  
Jesse R Fann ◽  
Kerry K McMillin ◽  
Jodie HN David ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Well Being ◽  
Cancer Center ◽  
Screening Methods ◽  
Distress Screening ◽  
Web Based ◽  
Care Services ◽  
Existential Crisis ◽  
Patient Health ◽  
English Speaking

134 Background: Addressing distress in cancer patients is now broadly recognized as critical to well-being and associated with increased survival. Cancer centers are developing innovative distress screening methods; we describe our novel process and results. Methods: New patients from 9/2015 to 3/2017 received an email requesting completion of a 44-item web-based survey assessing depression (2-item Patient Health Questionnaire), anxiety (2-item Generalized Anxiety Disorder), quality of life (QOL, 28-item Functional Assessment of Cancer Treatment-General), malnutrition (3-item Malnutrition Screening Tool), and 9 items addressing existential crisis, physical function, symptoms, tangible needs and concerns for dependent children. Results were computer scored, with positive screens resulting in direct, automated referrals to supportive care services (SCR). Analysis includes descriptive statistics and logistic regression using SAS 9.4. Results: 71% (n = 2629 of 3724) of those approached provided an email and completed the survey; 73% reporting no survey burden. Non-responders were more likely to be minority, non-English speaking, with non-commercial insurance (all p < 0.001). 59% (n = 1543) of responders screened positive for one or more SCR, including 6% to palliative care for poor QOL or symptoms. Receipt of SCR was more likely with Medicaid insurance (1.36 odds ratio [OR], 95% confidence interval [CI] 1.06-1.76, p = .0061); plan to receive care (1.27 OR, CI 1.07-1.50, p = .0061); and any report of survey burden (2.26 OR, CI 1.83-2.80, p < .0001). Conclusions: Web-based distress screening is feasible, efficient and not burdensome for the majority of cancer patients. Those who find this screening burdensome are two-fold more likely to have distress. Future efforts should address screening of vulnerable populations.

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