Distress is commonly experienced by individuals who are coping with the consequences of cancer. It is important to be able to identify those who would benefit from further assessment and intervention.
We designed an intentional approach to identify those experiencing distress and implemented a programmatic approach to responding to those with elevated levels.
The programmatic approach includes a standardized screening tool to identify distress, a brief assessment conversation with the individual, a subsequent dialogue for deeper assessment as required, and intervention or referral based on that assessment. Education, quality improvement cycles, evidence-based practice guidelines, and inter-professional team algorithms were incorporated. Audit feedback, marketing to patients, role changes and clarity, and specified operational accountabilities were additional strategies needed to overcome the implementation challenges.
Staff members report that conversations with patients are more focused on the concerns cited by patients and include more psychosocial aspects. The assessments provide a better opportunity to design a plan of care that is tailored to the individual patient and what is important to that person. Referrals have not increased to psychosocial experts as the majority of the issues are managed by the primary team of physician and nurse. Staff members indicated that it required a period of time to become comfortable with using the tool and incorporating the results into their routine practice.
Successful implementation of screening for symptom and emotional distress requires a programmatic approach. Screening must be followed by appropriate acknowledgement, assessment and intervention. Without an appropriate response by the health care professionals, there will be on-going challenges in achieving the desired outcomes.