ACOS, NCCN, the Oncology Nursing Society (ONS), and IOM each released statements highlighting the significant role that psychosocial health plays in an oncology patient’s course of care.1,2,5 NCCN urges health care workers to assess for distress at appropriate intervals, as indicated throughout their treatment and disease process.1,5 If screening is only performed one time in a patient’s course of care, a change in level of distress may go unrecognized and subsequently untreated.5 Therefore, psychosocial distress screening should be performed with each visit in the outpatient setting, especially prior to chemotherapy or radiation therapy.

In the inpatient setting the same screening tool can be used at key points, such as on admission to a unit, prior to surgery, post surgery, prior to chemotherapy, prior to bone marrow transplant, and at the time of discharge. When a patient is found to have psychosocial distress, the nurse should refer the patient to supportive services to more fully assess how the patient is coping and recommend additional interventions as part of the overall treatment plan.5

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Many interventions and referrals are available for the patient experiencing distress including chaplain services, outpatient psycho-oncology referrals, financial services, psychiatry, social workers, and psychiatric liaison nurses. The goal of psychosocial distress screening is to identify those in need of intervention and to utilize best resources possible for those interventions. If other providers fail to screen and treat patients with high levels of distress it may decrease their quality of life, jeopardize their outcomes, and increase health care costs.9


Implementing a nurse driven, standardized distress screening tool in the inpatient setting will help ensure that patients receive cohesive and consistent care in both the inpatient and outpatient settings while aspiring to improve quality of life and treatment outcomes for oncology patients. Nurses must become the leaders in developing and defining effective screening protocols for distress in order to provide patients with high quality, individualized care that addresses their emotional, physical, psychological, and spiritual needs throughout their journey of care. Future nursing-led research should focus on refining the screening process within the inpatient setting, creating practical referral systems, developing screenings for distress specifically within the pediatric and geriatric population, and coordinating care between inpatient and outpatient visits.

Tyler Cole works on a surgical oncology floor at the Medical University of South Carolina, in Charleston, South Carolina; he is also a Doctorate of Nursing Practice student at the Medical University of South Carolina College of Nursing. 


1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Distress management. (2014). National Comprehensive Cancer Network. Accessed February 13, 2015.

2. Clark PG, Rochon E, Brethwaite D, Edmiston KK. Screening for psychological and physical distress in a cancer inpatient treatment setting: a pilot study. Psychooncology. 2011;20(6):664-668. doi:10.1002/pon.1908.

3. Hegel MT, Moore CP, Collins ED, et al. Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer. 2006;107(12):2924-2931. Accessed January 23, 2015.

4. Adler NE, Page AEK, eds; Committee on Psychosocial Services to Cancer Patients/Families in a Community Setting; Board on Health Care Services. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: The National Academies Press; 2008. Accessed February 13, 2015.

6. Johnson RL, Gold MA, Wyche KF. Distress in women with gynecologic cancer. PsychoOncology. June 2010;19(6):665-668.

7. Buchmann L, Conlee J, Hunt J, et al. Psychosocial distress is prevalent in head and neck cancer patients. Laryngoscope. 2013;123(6):1424-1429. doi:10.1002/lary.23886.

8. Fulcher CD, Gosselin-Acomb TK. Distress assessment: practice change through guideline implementation. Clin J Oncol Nurs. 2007;11(6):817-821. doi:10.1188/07.CJON.817-821.

10. Pirl WF, Braun IM, Deshields TL, et al. Implementing screening for distress: the joint position statement from the American Psychosocial Oncology Society, Association of Oncology Social Work and Oncology Nursing Society. Published July 16, 2013. Accessed January 23, 2015.

11. Zabora J, BrintzenhofeSzoc K, Curbow B, et al. The prevalence of psychological distress by cancer site. PsychoOncology. 2001;10(1):19-28.