ANAHEIM, CALIFORNIA—Patients dealing with serious diseases will experience psychosocial distress. Detecting and recognizing patient distress early allows timely interventions and efficient psychosocial treatment that improves cancer care. A pilot program for early screening patients with breast cancer for distress was described in a presentation at the Oncology Nursing Society (ONS) 39th Annual Congress.

Guidelines from the NCCN and accreditation standards from the American College of Surgeons Commission on Cancer recognize the importance of distress screening. Although psychosocial care is recognized as important for people living with cancer, less than half of psychosocially distressed patients are identified and even fewer are treated.

Linda Abbott, RN, MSN, AOCN®, described the pilot program, enacted by the University of Iowa Hospitals and Clinics in Iowa City, in which the National Comprehensive Cancer Network (NCCN) Distress Thermometer was adapted to screen all postsurgical patients and patients with newly diagnosed breast cancer.

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The steps Abbott and colleagues took to develop the program were select a tool, determine how to administer it, establishing timing, assess patients and refer as necessary, and document of the process. The researchers chose the NCCN Distress Thermometer because it was comprehensive and adaptable, and standardized administration was established. Abbott recommends nurses review and edit the tool as needed to suit your patient population and facility needs. For example, they did not want to use the term concerns for problems because they felt it diminished the importance of the item to the patient.

The program was rolled out in three phases in the breast surgery clinic because postoperative follow-up return visit provided a consistent opportunity to assess patients. In phase I, the results were not entered into the medical record, but the social worker or American Cancer Society (ACS) navigator was paged if the patient’s score warranted a referral.

In phase II, modifications were made to the tool within the medical record. Patient scores were available for providers in real time. Providers could see these self-reporting results in real-time on an electronic medical record dashboard. Automatic pages went to the ACS navigator for scores of 1 to 5 and to the cancer clinic’s social worker for scores of 6 to 10. A tip sheet was developed for providers and an instruction sheet for medical assistants and nurses. The timing allowed for screening to fit within the workflow.

Phase III was a complete roll out of the program. It was expanded to all patients. The staff used tablets to complete the screen to facilitate entering the scores into the medical record.

The data from the pilot program indicated that the electronic screening increased both the percentage of patients screened and the percentage referred to social services, while the percentage referred to the ACS navigator decreased. The patients stated that they understood the questions and found them easy to answer on the computer; however, providers expressed concerns about patients having difficulty with the electronic nature of the screening.

The researchers concluded that quality of life is improved and adherence to cancer treatments is increased when patient distress is attended to. The electronic screening improved efficiency, consistency, and information availability compared with manual screening. These improvements led to more timely interventions. Abbott and colleagues reported that identifying the best time and place for patients to be screened, however, is a continuing challenge.


Abbott L, Phan T, Quinn G, West C. Distress screening: Meeting the American College of Surgeons Standards (ACOS) by 2015. Presented at: Oncology Nursing Society (ONS) 39th Annual Congress; May 1-5, 2014; Anaheim, CA.