Implementation of distress screening for breast cancer patients.

Abstract

196 Background: Cancer is a complex disease process. Patients experience psychological, social, financial, and behavioral issues that can interfere with their treatment plan and adversely affect their outcomes. Distress should be measured as the 6th Vital Sign. Consequences of distress can cause deterioration of Quality of Life; produce higher levels of pain; longer rehabilitation; reduced adherence to treatment with less efficacy; and shorter survival expectancy. Methods: Problem exists with a lack of screening patients’ level of distress during breast cancer experience within their cancer care continuum. Goal was to improve the prevalence of distress screening of breast cancer patients from 0% to 50% within 3 months. Cause and effect analysis showed evidence of areas for improvement. Improvements and interventions included: education on stress and psychosocial assessment; developing a distress screening tool; and developing inclusion criteria for patient screening. Screenings were completed on first follow-up visit after diagnosis with continuation of assessment every three months for the first year. A distress screening tool with a thermometer illustration was provided to the patients for them to rate amount of distress experienced in the past week. Scoring was “0 = no distress to 10 = extreme stress.” The tool also included Yes/No questions. A value of 4 or greater on the thermometer or any question marked “Yes” on the questionnaire was considered a positive screen. Results: In addition to developing a tool, a template was implemented in the electronic medical record. Opportunities for assistance with distress were discovered based on patients’ responses where interventions and follow-ups with the patient were provided. Conclusions: A process was developed and implemented to integrate and monitor on-site psychosocial distress screening and referral for provision of psychosocial care. A small number of patients analyzed met criteria during a short period of time. The percentage of distress screenings completed improved from 0% to 92%. [Table: see text]