An Important Role for Rating Scales

An integral part of the program was having the patients complete rating scales at each visit, including scales for measuring pain, emotional distress, generalized anxiety and depression disorder (GAD), symptoms such as nausea, and financial distress. Ms Reiser explained that because the scales made patients’ difficulties in each category more measurable, clinic nurses found talking with patients about their difficulties was easier. “We can see the severity of different things like how financially distressed the patient is going to be, and if we look at that scale we can explore those options deeper,” she explained. “We obviously can’t cover everything, but if we see that a patient’s financial distress is much higher and her nausea scores are also higher, then those are the things we can focus on.”

The day before the meeting the nurse navigator reviews the patients’ charts and all their scores. She reads any notes that the palliative care clinicians have made delineating the patient’s needs.  The next day she leads a 1-hour meeting with the whole team. They review a list of patients who will be coming to the clinic. They also take note of patients new to the MBC-SEA program so those patients can be given a packet containing educational and counseling materials.

Continue Reading

The nurse navigator has flagged some patients on the list as requiring more discussion, and the group discusses those patients further. Approximately 60 to 75 patients with metastatic breast cancer are treated at the clinic each week, but not all of them score high on psychosocial distress. However, for those who do, the staff alerts palliative care, social work, the collaborative practice nurses, and the nurse practitioner of their needs. Patients’ needs are addressed at clinic the following week, and the patients complete the rating scales at each subsequent clinic visit. This allows the researchers to track their scores and ascertain improvement.

With the MBC-SEA Program of Care in place, the team found a statistically significant increase in referrals to palliative care and social work, and a subsequent significant decrease in generalized anxiety, distress, and symptom severity. They inferred that the improvement took place because the nurse navigator was able to coordinate the referrals needed to address patients’ needs.

The Takeaway

“I’d look at what available resources are already being used to evaluate a patient, whether it’s a pain score, or if the patient is coming in more often, maybe she’s having readmissions. If there is no scale to measure anxiety and distress, discuss creating one with other staff,” Ms Reiser advises oncology nurses in local hospital clinics. “And of course, the nurse should discuss these things with the patient, because it’s so important.

“Ultimately these symptoms are going to affect her quality of life and other medical outcomes. If we’re able to better control a patient’s symptoms and she’s better able to handle her finances, then it will be easier for the patient to come in to the clinic and get treatment.”

The MBC-SEA team told Oncology Nurse Advisor that they want to give people hope, no matter what stage their cancer is. Ms Reiser added, “I think there has to be hope in every day. We talk about quality of life and helping each person to find the meaning in her life whatever that is for her.”


1. Reiser V, Rosenzweig M, Welsh A, Ren D, Usher B. The Support, Education, and Advocacy (SEA) Program of Care for Women With Metastatic Breast Cancer: a nurse-led palliative care demonstration program [published online April 11, 2019]. Am J Hosp Palliat Care. doi: 10.1177/1049909119839696