The Commission on Cancer (CoC) has recommended regular on-site psychosocial distress screening for all cancer patients outlined in Cancer Program Standards 2012: Ensuring Patient-Centered Care. The CoC emphasizes the importance of screening patients as a critical first step to providing high quality healthcare. According to Institute of Medicine, distress is any psychological, behavioral or social problems of a patient that interferes with their ability to participate fully in their health care and manage their illness and its consequences.
“Distress should be recognized, monitored, documented and treated promptly at all stages of disease,” recommends the CoC. The goal is to identify patients with distress or barriers to care and provide them with resources or referral to healthcare providers prepared to modify their identified problems.
The CoC recommendation is a huge advancement in keeping with up the great strides in medical treatment over the past decade. Now cancer patients can be ensured that their psychosocial needs will also be addressed.
Like any new mandate, the question arises, “Who will be responsible for implementing the standard?” It seems fairly obvious that the responsibility will fall mainly to nurse navigators because of their continuous relationship with the patient across the continuum of cancer care. Other appropriate caregivers for patient assessment include oncology social worker, clinical psychologist or other mental health professional.
The Nurse Navigator’s role has traditionally included reducing patient barriers and relieving psychosocial stress through education. The major difference with the new recommendations for most Navigators will be that these assessments now have recommended criteria on time of administration, documentation of referral and follow-up.
Implementing Process Requirements:
A distress assessment should be made soon after a patient enters into care to remove any barriers that could prevent them from receiving adequate medical treatment for their disease.
- Recommended distress screening times are at major transitions in care: diagnosis, presurgical and postsurgical visits, first visit with medical oncologist, first visit with radiation oncologist, post chemotherapy or radiation therapy treatments, and any major transitions during and after treatment.
- The results of the assessment should to be documented and referral to an on-site or outside care facility should be made to address problem.
- A report on findings and referrals should be made to the cancer committee annually.
- The assessment can be a written patient questionnaire or a clinician-administered questionnaire.
Distress Assessment Tool:
- The distress assessment tool should be a standardized, validated instrument with established clinical cutoffs. Each facility can determine the cutoff score used to identify distressed patients.
- Patients identified with distress (barriers) should be addressed with appropriate interventions by the Navigator or referred to resources either on-site or to community resources.
Documentation of Distress:
- Screening, referral or provision of care and follow-up should be documented in the patient medical record to facilitate integrated high-quality care.
Facility Guidelines for Meeting Compliance:
- Cancer committee develops and implements a process to provide assessment and monitor on-site psychosocial distress screening.
- Conduct a community needs assessment at least once every 3 years.
- National Comprehensive Cancer Network has a distress assessment tool available free by contacting them and asking for permission to use tool.
- Determine clinician to administer
- Determine major care transitions of care to conduct assessments
- Cancer committee referral for provision of psychosocial care and follow-up
- Review all barriers to care and establish referral methods
- Social Work
- Psychosocial services
- Screening assessment, referral or provision of identified barriers to care and outcomes of referral should be documented in patient record.
- Navigation software program
The new CoC accreditation standard for regular distress assessment is a major advancement in providing patient-centered care. You can download it here. Nurse Navigators will play a major role in facilitation of this new standard. How do you see it impacting your role in caring for your patients?