Category IV: Psychosocial Support, Assessment

October 2022 Vol 13, No 10 —November 7, 2022

D1 Oncology Nurse Navigators Improve Psychosocial Distress Screening Compliance During First Course of Cancer Treatment

Jose Irizarry, Charity Zayas, Cenizia Baid, Diana Labrador, Claudia Blandon, Morgan Nestingen, Tania Silva Santos, Barbie Quintana, Marguerite Rowell

Miami Cancer Institute, Miami, FL

Problem: Staff faced challenges completing timely psychosocial distress screening due to operational workflow, role confusion, timing of screening, and paper versus digital screening. Delayed screening prevented timely initiation of psychosocial support services.

Background: Per the Commission on Cancer (CoC) Standard 5.2, cancer centers must screen cancer patients once during the first course of treatment and provide psychosocial support services, as needed.1 Cancer-related distress is highly prevalent (up to 43.4% of cancer patients) and unrecognized, is associated with depression, and may worsen morbidity and mortality.2 Timely screening and identification of distress assist clinicians in addressing barriers to care, providing support services, and treating anxiety or depression.3 At Miami Cancer Institute (MCI), psychosocial distress screening was initially performed by medical assistants (MAs) during the initial visit. MAs documented distress using the National Comprehensive Cancer Network Distress Thermometer and Problem List via paper forms and/or discrete electronic health record (EHR) fields; a cutoff score of 4 was used to automatically trigger psychosocial support referral. Early audits demonstrated a baseline screening compliance rate of approximately 50%, placing MCI at risk of CoC deficiency and patients at risk of unrecognized distress.

Objectives: To (1) implement a rapid-cycle Plan-Do-Study-Act project to increase distress screening compliance rates by capitalizing on the clinical knowledge of oncology nurse navigators (ONNs) and aligning screening with initial navigation assessment, (2) improve ONNs’ ability to address barriers to care, and (3) ensure timely referral to psychosocial support services.

Methods: (1) Plan: ONNs collaborated with social workers (SWs), MAs, nurse educators, and leaders to review CoC criteria, baseline data, staff education, and competencies and plan a pilot intervention. (2) Do: In January 2021, the genitourinary ONNs piloted the initial practice change, performing distress screening on first visit with real-time EHR documentation and automatic referral to SW. (3) Study: Patient navigators performed manual audits to assess distress compliance in the pilot group. (4) Act: The navigation team iteratively rolled out ONN distress screening across all disease sites prior to May 2021 and performed additional manual audits. Leaders incorporated distress screening compliance into standard program reporting and met with the Cancer Committee to present project findings and established benchmarks.

Results: In 2021, the navigation team performed 3414 initial distress screenings and 2622 reassessments; these triggered 1598 automated referrals for psychosocial support services in patients with moderate or severe distress. Compliance by quarter improved over time (CY21Q1 82%, CY21Q2 85%, CY21Q3 84%, and CY21Q4 95%). A first-year benchmark of 90% was established for 2022 and initially exceeded with a compliance rate of 93% in CY22Q1; the team established a subsequent benchmark of 95%.

Conclusions: MCI’s navigation team successfully improved screening compliance by aligning screening with initial navigation assessment and provided timely identification of distress and support for cancer patients. Challenges included staff buy-in, including the perception of “extra work,” lack of reporting tools, timely distress documentation, and duplication of referrals to SW. Other cancer centers may benefit and improve screening compliance by incorporating distress screening in their navigation assessments and establishing clear task ownership, reporting tools, and automated referrals to supportive services.


  1. Commission on Cancer. Optimal Resources for Cancer Care: 2020 Standards. cer/standards-and-resources/2020/.
  2. Ercolano E, Hoffman E, Tan H, et al. Managing psychosocial distress: lessons learned in optimizing screening program implementation. Oncology (Williston Park). 2018;32:488-493.
  3. Ownby KK. Use of the distress thermometer in clinical practice. J Adv Pract Oncol. 2019;10:175.

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D2 Social Media as Community-Building and a Support Tool Among Young Breast Cancer Previvors and Survivors, Metastatic Breast Cancer Patients, and Their Caregivers: The Sharsheret Experience

Adina Fleischmann, Melissa Rosen, Jenna Bresge, Catherine Dunn, Kenneth P. Tercyak

Sharsheret, Teaneck, NJ

Background/purpose: About 1 in 40 Ashkenazi Jewish women carry a BRCA mutation predisposing to hereditary breast/ovarian cancer (HBOC). Sharsheret is a national nonprofit linking Jewish women of all backgrounds with educational and supportive programs addressing their comprehensive HBOC needs. Sharsheret navigates young breast cancer previvors and survivors (YBCS) and metastatic breast cancer (mBC) patients across HBOC prevention, to diagnosis, to survivorship. Sharsheret utilizes social media (SM) to promote program awareness and engagement and connect people with shared interests. Here we describe findings from Sharsheret’s SM communications strategy to inform similar efforts nationwide.

Methods: In late 2019/early 2020 (pre-COVID), Sharsheret surveyed N = 393 community members and conducted 20 key informant interviews with stakeholders who had utilized its programs within the past year.

Results: Overall, 63% of respondents “frequently” utilized SM in their everyday lives, and 38% viewed Sharsheret SM platforms. Among viewers, Sharsheret’s most utilized platforms were Facebook (58%), Instagram (34%), and YouTube (16%). Demographically, YBCS were among the most likely to follow Sharsheret on SM (44%). On a multidimensional scale evaluating SM engagement (Cronbach’s alpha = 0.91), Sharsheret SM uniformly met constituents’ expectations for its postings as being helpful/meaningful (82%), of “newsworthy” value (84%), topic relevant (54%), informative about upcoming events (72%), beneficial (54%), inspirational (78%), and actionable/navigable (71%). Age was inversely associated with SM engagement, as younger respondents were more engaged (r = -.22, P = .01). Key informant interviews revealed constituents were more likely to engage with SM content if/when it featured stories related to their personal circumstances (eg, YBCS on survivorship, mBC patients on palliative care).

Conclusions: SM communication has emerged as an essential public health tool that organizations such as Sharsheret use to address the comprehensive HBOC needs of YBCS, mBC patients, and caregivers. Targeted and tailored SM about HBOC, segmented to different audience types, is essential to promote engagement.

Acknowledgments and funding: This work was supported by the Centers for Disease Control and Prevention (U58DP006670) and the National Cancer Institute at the National Institutes of Health (P30CA051008).

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Last modified: August 10, 2023

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