Studies reported at the 2016 Oncology Nursing Society Annual Congress indicate that distress screening is slowly gaining traction in practices, and patients are benefiting.
Cancer centers are now required by the Commission on Cancer to routinely screen for psychosocial distress. Incorporating distress screening and assessment is considered vital to providing comprehensive quality cancer care.
A “rapid cycle improvement” project increased distress screening by 16% over 8 months at Baylor Scott & White McClinton Cancer Center in Waco, TX. The study was led by Poppy Patterson, BBA.
Ms Patterson and her team identified 363 patients who came for an initial consult but were not all screened for distress. They identified several issues that contributed to this lack of screening: a developing cancer center with rapid volume growth, rotating providers, and multiple clinic subspecialties, along with a knowledge deficit among some team members.
They initiated a multidisciplinary screening pilot during which they identified and implemented various approaches to improvement. These strategies included staff training, development of a reusable screening tool, delivery of the tool by a delegated person, and charting and reporting within the electronic medical record with follow-up by the supportive care team.
The pilot resulted in a 16% increase in patients screened, translating into an 84% current distress screening rate, Ms Patterson reported.
“When patients are not initially assessed, the supportive oncology team identifies the next opportunity for assessment, leading to near 100% capture,” she noted.
The evolving process increased communication among physicians, clinic nurses, nurse navigators, the financial navigator, social worker, dietitians, and schedulers and has ensured that patients receive “the ongoing care needed to support holistic cancer care.”
Screening of Breast and Gynecologic Cancer Survivors
Cynae Johnson, MSN, CRNP, OCN, of Johns Hopkins University School of Nursing, Baltimore, MD, led a gap analysis to identify whether the needs of breast cancer survivors (BCS) and gynecologic cancer survivors (GCS) were being met at her institution. She and her team interviewed patients after completion of their primary cancer treatment to determine the degree to which their healthcare provider had assessed and managed their distress.
Approximately one-third of BCS are believed to demonstrate some signs of “distress,” whereas the incidence among GCS has not been established, said Ms Johnson, who is a survivorship nurse practitioner. Especially for GCS, little is known about sources of distress, and any conclusions have been extrapolated from studies in BCS, which is felt to be a similar cancer experience for women.
The National Comprehensive Cancer Network (NCCN) has recommended the NCCN Distress Thermometer as the instrument of choice for measuring cancer patients’ distress. The researchers assessed its use in this setting.
Information from Focus Groups and Distress Thermometer
Ms Johnson and her team sampled 19 BCS and GCS in focus groups, who were 63% Caucasian, 26% black, and 11% of other ethnicities. The researchers were especially interested in the experience of underserved patients.
They found that BCS were more likely to report having been assessed for distress and/or having issues addressed (66.7%) than GCS (30%), but their assessment was not done with the NCCN Distress Thermometer (which was not standard at the time) and lacked an emotional component (ie, was based on physical concerns). BCS were also more likely to have been referred to a supportive service (44.4%) than were GCS (20%).
“The breast group had nurse navigation and a monthly support group, and those services did improve distress in that group,” she pointed out.
Patients reported, in interviews, that nurse navigators (33%) and support group services (66%) had improved their distress, but 90% of GCS said they relied on self-navigation for supportive resources.
On the NCCN Distress Thermometer, they found the scores (0-4 scale) similar between the groups: 3.33 for the BCS and 3.00 for the GCS. The groups differed somewhat, however, on the types of problems they reported (Table).
“The gynecologic cancer survivors reported higher practical and physical problems compared to the breast cancer survivors,” Ms Johnson noted.
More than 78% of both groups rated the NCCN Distress Thermometer as easy to use. The instrument captured most sources of distress except hospital administrative issues, she noted.
As a result of the study, her department now offers more support groups and is expanding its navigation work by training the nurses to assume these roles. “We have to figure this out with limited resources. We can’t hire all the nurse navigators we want, so we are looking at creative ways,” she said.
They are also implementing formal distress screening and linking patients to referral services as needed.
Patterson P, King M, Pederson J. Process of improvement in distress screening. 2016 Oncology Nursing Society Annual Congress. Poster 11.
Johnson C, George M, Angarita A, et al. Exploring distress in breast and gynecologic cancer survivors. 2016 Oncology Nursing Society Annual Congress. Poster 223.