Approximately 20%–40% of patients with cancer show significant stress; however, less than 10% identify that they are distressed. Distress impacts quality of life, employment functioning, medical adherence, medical costs, health risk behaviors, and health protection behaviors. Treating distress properly in this patient population can lead to better treatment adherence, better communication, fewer calls and visits, avoidance of feelings, and better trust between patients and all healthcare providers.

Renee Barwick, RN, OCN®, and Wendy Schulz, MSW, OSW-C, both from the Aspirus Regional Cancer Center in Wausau, WI, discussed the importance and standards of distress screening for improved cancer care during a poster session at the ONS 41st Annual Congress in San Antonio, TX. The poster was titled “Implementing Standards to Enhance Patient Experience.” 

Distress management is a component of quality oncology care, and cancer centers accredited by the American College of Surgeons’ Commission on Cancer must have distress screening in place. The researchers noted that patients should be screened for distress at the following pivotal healthcare visits.

  • At new consult and initial clinic visit
  • At the start of chemotherapy or change in treatment
  • At the start of radiation treatment
  • At the end of treatment for survivors
  • When there is a change in disease status

The researchers discussed the distress screening implementation process at their organization.

  • Developed a cancer committee
  • Presented data to Aspirus Regional Cancer Center Operations Meeting
  • Met with individuals in the organization to educate them on the new distress screening process (including those in financial, nursing, nutrition, pastoral care)
  • Implemented the Psychosocial Distress Screening for new consults in January 2013
  • Met with the nursing staff to educate them on the screening process
  • Expanded the screening to include additional pivotal visits mentioned above in September 2013
  • Modified auditing to include looking at the increased pivotal visits in May 2014
  • Completed monthly auditing and tracking
  • Made modifications to the screening tool as needed
  • Reported monthly to the nursing supervisor
  • Conducted quarterly education and updates with the nursing staff
  • Reported to cancer committee twice each year
  • Psychosocial Distress Screening process was included in the orientation of all new nursing staff hires

The researchers concluded that the program enhanced patient awareness of and access to support services earlier in the cancer journey, increased coordinated care for both patients and families, demonstrated a need for increased staff, led to an increase in social work full-time staff for cancer programs, and led to the development and implementation of a financial counselor position for the program.

Barwick, R., & Schulz, W. (2016). Implementing standards to enhance patient experience. Poster presented at the ONS 41st Annual Congress, San Antonio, TX, April 28–May 1, 2016.

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