“Cancer is like a Rubik’s Cube; a complex, unique experience with twists and turns [to find the right treatment],” Linda Watson, RN, PhD, OCN®, lead, person-centered care integration, Alberta Health Services in Canada, said during a session on distress screening at the ONS 40th Annual Congress in Orlando, FL.

Living with cancer is much like a maze, Watson said. Even though cancer care is rooted in generalizable knowledge, including specific types of cancer, the stage and pattern of progression, evidence-based guidelines, and side effects and risk factors, a balance must be struck between the general and the specific by focusing on how each applies to the individual patient.

Person-centered care is responsive to a person’s needs, values, and preferences; it allows patients and families and caregivers to participate in health decisions. Overall, it provides a system of support. 

The Institute of Medicine (IOM) defined high-quality care as safe, effective, person-centered, timely, efficient, and equitable. Benefits of person-centered care include an increase and improvement in the following, according to the IOM.

  • Patient satisfaction
  • Clinical outcomes and safety
  • Use of supportive care resources
  • Effective interdisciplinary collaboration
  • Care that is reflective of patient and family concerns
  • System efficiencies so that patients are connected to the right provider in a timely way
  • Equitable care

This form of care also decreases anxiety, overuse of medical resources, and cost.

“Distress is an umbrella term,” Watson said. The National Comprehensive Cancer Network (NCCN) defines distress as “an emotional experience of a psychological, social, and/or spiritual nature that can be caused by physical, psychosocial, or practice issue.” Approximately 35%–45% of patients  with cancer experience significant distress, according to the NCCN, and it is endorsed as the sixth vital sign that calls for routine monitoring.

“Screening is just a piece of paper. What makes it valuable is discussing it with patients,” Watson said. “As practitioners, we are socialized to be in control,” although talking about distress allows for a conversation in which patients are more in control, providing their own opinions, she noted. Screening should be accompanied by a conversation that contextualizes the screening data to provide meaningful care to patients. Screening does not create new concerns; it is an approach to manage and intervene on issues that are already concerning for patients according to Watson.

Distress screening is a standardized tool that enables proactive, rapid identification of key indicators that allow for further assessment and appropriate referral for additional care and/or support.

Watson noted that staff at her facility were surveyed on their thoughts of the distress screening tool implementation. Positive comments received included comprehensive picture of patients, more focused assessment, increased contact with patients needing symptom management, and improved documentation. Negative comments received included time consuming, details not relevant to care, made patients overly emotional, and made the healthcare provider feel uncomfortable.

To get healthcare providers on board with implementing a distress screening, they need to recognize the need for and obligation of the testing. To make the program successful, the screening needs to become part of a therapeutic conversation and ongoing relationship, not merely a procedure.

Watson, L. (2015). Distress screening: The sixth vital sign. Session presented at the ONS 40th Annual Congress, Orlando, FL, April 25, 2015.