Introduction

Cancer and its treatment have more than a physical impact on individuals and their family members. There are also emotional, psychological, spiritual, and practical consequences of the illness. These consequences are unique to each individual and may appear at any time in the cancer experience and in any combination. Dealing with these consequences can bring about psychosocial distress and influence quality of life for the breast cancer survivor. 

Method

Screening for psychosocial distress is a programmatic approach to identifying those individuals living through a cancer experience who are having psychosocial difficulties and intervening to prevent increases in distress levels or mitigate the effects. Standardized screening tools (e.g., ESAS, HADS, Distress thermometer) are used to capture patient/survivor input on symptoms and emotional challenges. Clinicians respond to the scores from the screening and provide the relevant intervention for the individual’s distress and situation. 

Results

Using a programmatic approach to screening for distress can be effective in identifying the individuals who have high distress and require intervention. Between 35%-40% of cancer patients have levels of distress that warrant intervention by healthcare professionals; the remainder can be supported through tailored education, peer support and community-based resources. Key factors for implementing a successful program of screening include leadership, clarity of expectations, regular feedback on progress, and continuous quality improvement attitude.  

Conclusion 

Implementing a programmatic approach to screening for distress is critically important for the success of the initiative. Screening for distress must include follow-up by clinicians. It requires intentional efforts to ensure adequate processes and procedures to respond to patient needs.

Margaret I Fitch, RN PhD, is a Professor (Adjunct) at the Bloomberg Faculty of Nursing, University of Toronto, in Canada. She has a background in oncology nursing and psychosocial oncology, including palliative care, practicing for over 20 years at the Odette Cancer Centre in Toronto. She held the positions of Head of Oncology Nursing and Psychosocial Oncology, and Co-Director of the Psychosocial and Behavioral Oncology Research Unit.

Her long-term research focus has been on coping and adaptation of patients/survivors and families across the cancer trajectory. Advocacy for patient and stakeholder engagement has been a specific interest. Psychosocial care along the cancer trajectory and survivorship are the broad foci for her research work and teaching.

Dr. Fitch currently serves as Editor-in-Chief of the Canadian Oncology Nursing Journal and is on the Board of Directors with the Canadian Association of Nurses in Oncology.