Psychosocial Distress Screening for Patients with Cancer: A Value-Based Approach to the Integration and Delivery of Holistic Care

Background: Patients with cancer (PWC) have a high prevalence of experiencing psychosocial distress as they bear the burden of the disease. Emphasis is needed on psychosocial care, as the COVID-19 pandemic negatively impacts mental health. Psychosocial distress screening is considered a standard practice by the National Comprehensive Cancer Network (NCCN), which recommends using the validated Distress Thermometer (DT) as a screening tool. Local Problem: The DNP project ambulatory infusion clinic (AIC) site does not have a standardized distress screening tool for staff. There was a lack of awareness of an existing non-validated distress screening and little to no intervention or process for addressing distress in cancer patients. Methods: Nurse Practitioners (NPs) were given a pre-intervention survey to assess their knowledge of distress screening and later received an educational module on the importance of screening. They were given a post-intervention survey to assess their frequency of distress screening, knowledge, acceptability, and efficacy of the DT. The DT questionnaire was distributed to hematology patients to assess distress levels and referral needs. Interventions: The implementation of the DT screening across all hematology patients at the ambulatory infusion clinic. NPs received a DT educational training module and patients were provided a pamphlet with psychosocial resources or referred appropriately. Results: Distress screening by NPs increased from 50% to 60%. The DT had low efficacy and acceptability by NPs. None of the patients that met the cutoff score ≥4 received referrals. Reasons included (a) they already have resources or support, (b) they did not perceive their distress to be severe enough for interventions, or (c) mental health stigma. All the screened patients were offered an educational pamphlet on distress with resources. Two patients suggested including more COVID questions due to the impact of the pandemic on their distress. Another questioned the accuracy of the screening because the DT only assesses the patient’s level of distress experienced in the past week rather than an extended time. Conclusions: Screening PWC for psychosocial distress is vital for delivering thorough care, and opportunities to optimize screening and mitigate psychosocial distress are readily available. One of the core challenges is having institutions adopt a standardized screening tool. Recommendations for institutions to improve distress screening consist of (a) selecting a standardized screening tool, (b) incorporating the tool in the electronic health record to improve clinician workflow, and (c) ongoing education and training on distress screening for new and current clinicians. Keywords: Psychosocial distress, cancer care, distress, oncology, psycho-oncology, psychosocial screening, psychosocial suppor