Implementing a Distress Screening Process for Cancer Patients

Economics As with any change to a process, the economic impact needs to be considered. Evidence shows that when patients feel their emotional needs are not being met, they are more likely to seek out other clinics and emergency care services.^4,17

Implementing a change would cost very little. The nurse at the chair-side should be able to assist a patient who reports a distress score of 4 or lower. A patient who reports a score of 5 or higher could be referred to the oncology nurse navigator (ONN).

The ONN can take the lead in assisting the patient, families, and caregivers. ONNs are more likely to be aware of local, regional, and national support resources, as there are benefits in developing resources that meet a variety of needs.

Future studies could compare the benefits of distress screening and referran to an ONN with outcomes for patients not screened for distress. Outcome measures include utilization of emergency and primary care offices for problems not addressed in the oncology setting. From there, lobbying and networking with insurance companies could assist in improved mental health coverage.

Institutions Health care institutions should embrace the change and see this as best practices for treating psychosocial distress in the clinical setting. Patients should no longer be treated for 1 problem at a time. Recognizing that distress impacts a patient’s cognitive and emotional function as well as quality of life is essential.¹⁸ Assessing and treating distress early could decrease hospital admissions. The cost of adding distress screening to routine assessment is minimal.

Health care institutions should evaluate the need for outpatient mental health services for patients with cancer. Even though mental health is considered an essential part of overall health, it is often overlooked.¹⁹ Mental health also impacts other aspects of overall health, including employment, personal, and family life. In our study, worry, fear, sadness, nervousness, and depression were patient concerns we encountered. Depression can be overpowering for anyone, but for the patient with cancer, it can affect how well they cope with treatment.²⁰ Developing a mental health program that provides individual and group support is necessary to meet more patients’ needs.

One in 3 adults with cancer experience anxiety.²¹ Support groups and other resources are needed for patients who do not need formal mental health care but could benefit from support services. Health care institutions should consider developing professionally led support groups, as these are preferred over patient-led groups.²² There is strength in numbers; patients find it helpful to meet someone with a similar experience.²³ There are currently no active professionally led support groups within the community setting where our study took place.          

Nursing Nurses are vital to implementing and sustaining a distress screening process. They are the frontline staff who can assist with identifying patients’ support needs.²⁴ Nurses are often best able to identify and provide resources that help meet patients’ needs, which may already occur during conversations with the patient. Despite this, research has shown that in some settings, nurses often score a patient’s distress significantly lower than the patient does.

Recognizing the impact screening can have on quality-of-life will best allow for meeting patients’ needs.²⁵ Our study adds to the body of knowledge that screening for distress can make a difference in the lives of our patients and provides another example that demonstrates the value of change.