Implementing a Distress Screening Process for Cancer Patients

DISCUSSION

The distress screen requirement for accredited cancer programs has impacted all facilities. Each program must determine the optimal time to screen and how to assist its patients. In this project, we explored the distress experienced by patients with cancer in relation to their demographics, past treatment, and the relationship between problems and distress levels. Using the information obtained, we can implement changes that improve the current screening and referral process for our patients.

For the purpose of this study, we made the following assumptions: The participants in this study may be at risk for cancer-related distress. The participants will answer all questions truthfully.

One limitation of this study, however, is that it is a cross sectional study and data were obtained at 1 point in time. Current experiences of that day could have affected participants’ answers. For example, if the patient had not rested well the night before, this may reflect as a higher level of distress than if the patient had slept better. There is the possibility that a view may change over time related to a change in the circumstances.

DEMOGRAPHICS AND RISK FOR DISTRESS

Our results showed that females had a higher level of distress than males. However, females are more likely to express emotions and discuss psychological distress than males.¹⁴ Females are also more open with their feelings and more comfortable discussing emotions.

Overall, the average distress score for most of the participants was 3. The 46-to-55-years age group had a mean distress score of 5.3. This could be attributed to being the sandwich generation, meaning they are both raising children and caring for aging parents. Their caregiving responsibilities could be placing a higher level of stress on them while they are facing cancer treatment. Further assessment of this age group would help identify their unique needs.

Whether one cancer type causes patients more distress than another has been investigated in other studies, with similar results. More patients in our study had breast cancer so small sample size in the other cancer types may account for differences in mean scores. Mean distress score in patients with lung cancer was 4. The fact that lung cancer is the second most common cause of death in both men and women could cause more distress.¹⁵ The other notable diagnosis was head and neck cancers. Our results were similar to a study by Singer and colleagues that showed patients with head and neck cancers experience more emotional distress.¹⁶

TREATMENT EXPERIENCE AND DISTRESS

Mean distress score was higher for participants undergoing radiation (3.8) than for those receiving chemotherapy (2.6). Radiation is typically administered daily for several weeks, challenging patients and families in regard to transportation, gas, or managing side effects. The specific problems identified between the 2 treatment modalities should be explored further.

Mean distress score was higher for those patients who had no prior cancer treatment, possibly due to newly diagnosed or earlier stage disease. A patient who has undergone prior chemotherapy or radiation treatment may have already identified resources to assist with coping or financial needs.

The patient in our study who was undergoing concurrent treatment with radiation and chemotherapy reported a distress score of 3. When working with a patient receiving concurrent treatment, consider that distress could be higher as they are undergoing 2 intense treatments simultaneously.

Reported distress levels were different at various points in patients’ treatment cycles. Of those patients who could remember their number of treatments, lower distress levels were reported by those in their third treatment cycle to the halfway point (mean score 2.7). The highest distress levels were reported during the second cycle/week of treatment (mean score 5.8). Causative factors include initial experiences with treatment, acute awareness of side effects, receiving bills, or facing emotional changes.

Between the second and third cycle/week through the halfway point, the patient is adjusting to the new schedule and finding ways to adapt. Once the patient is past the halfway point, the distress score increases again. Further research could explore the relationship between distress level and number of treatments, and identify an optimal point for assessment.

IMPLICATIONS FOR HEALTH CARE

Policy With commitment from facilities to enact policy changes, screening procedures need to be evaluated. Based on these results, screening more than once during treatment is necessary. The distress screening policy should consider the points when distress is likely to be higher. This study indicates that point is at the second cycle/week of treatment, and distress should also be assessed before the end of treatment as well.

In addition, a policy change in regard to nursing education is needed. Nurses should undergo training on distress screening annually. Education could be accomplished through posters, testing, or even during yearly simulations. Identifying the value of screening to the nurse is imperative.