Tag Archives: CoC Standard 3.2

Journeying Beyond the Physical: Addressing a Patient’s Spiritual Concerns

By Susan van der Sommen, MHA, CMPE, FACHE

HC provider cupping patients hand (for web)Based on evidence presented in the Institute of Medicine’s 2008 report, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,” the American College of Surgeons Commission on Cancer (CoC) has phased in a new standard – 3.2: Psychosocial Distress Screening. The goal of utilizing a psychosocial distress screening tool is to ensure patients’ emotional and psychological needs are being addressed – in addition to their physical disease and symptoms.  CoC Standard 3.2 includes the following description of the psychosocial assessment:  “This assessment will confirm the presence of physical, psychological, social, spiritual [emphasis added], and financial support needs and identify the appropriate referrals as needed.”

In an article published in the March/April 2017 edition of ACCC’s journal Oncology Issues, the Reverend Lori McKinley outlines how Mercy Health lived up to its promise to “make lives better – mind, body and spirit” by incorporating a rating for various spiritual concerns of a patient or loved one. The Spiritual Care Team at Mercy recognized that just addressing emotional and physical needs of patients is not enough.  After performing an extensive literature review and developing connections with community-based organizations, the Mercy team made significant quality-related, evidence-based changes to their electronic health record (EHR) to accommodate a new and improved distress screening tool. Learn more about their pilot project here.

Indeed, a patient’s spirituality is directly related to their quality of life and has a direct correlation to giving  patients meaning, a sense of purpose and understanding during a critical time in their lives. In “Spirituality in the Cancer Trajectory,”  author C.M. Puchalski writes that “Spirituality is an essential element of person-centered care and a critical factor in the way patients with cancer cope with their illness from diagnosis through treatment, survival, recurrence and dying.” Her article goes on to identify the link between spirituality and “inner peace, gratitude and positivity” when facing a life-changing diagnosis such as cancer. She writes that with proper support, a patient may begin to view their cancer diagnosis as a positive life-changing experience, ultimately paying greater time and attention to higher priorities in their lives. This is not possible if a patient’s spiritual needs are not addressed routinely throughout their care.

Puchalski further points out that religion is but one type of expression of spirituality so non-faith based organizations should not dismiss the concept or its importance. In fact, she writes, a majority of patients want their oncologist or healthcare professional to address their spiritual concerns and integrate their needs and wishes into their care plan.

Not surprisingly, this is what the Spiritual Care Team at Mercy discovered during their pilot program. With the addition of four questions addressing spiritual concerns in their distress screening tool, they were able to more effectively connect patients with their faith, alleviate fears, and assist patients with addressing their trepidation at the end-of-life. Isn’t that what all of us want for our patients?


Puchalski CM. Spirituality in the cancer trajectory. Ann Oncol. 2012;23(suppl_3):49-55.

Contributing blogger Susan van der Sommen, MHA, CMPE, FACHE, is Executive Director, DSRIP, Bassett Healthcare Network, and Chair of the ACCC Editorial Committee.


Navigation Documentation Tools Can Support Compliance with Commission on Cancer Standards

By Tricia Strusowski, MS, RN

ThinkstockPhotos-180686516Documentation by oncology patient navigators can play an important role in your cancer program’s efforts to comply with the new Commission on Cancer (CoC) Standards that became effective in 2015.  This blog reviews documentation-tool compliance—in other words—how your documentation tools can help you demonstrate compliance with CoC Standard 3.1 Patient Navigation Process and Standard 3.2 Psychosocial Distress Screening.

Let’s start with a review of key elements of these standards:

Standard 3.1: Patient Navigation Process

A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients.  Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations.  The navigation process is evaluated, documented, and reported to the cancer committee annually.  The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment . . . .

Prior to establishing the navigation process, the Cancer Committee conducts a community needs assessment to identify the needs of the populations served, opportunities to improve cancer health disparities, and decrease gaps in resources. This assessment reoccurs at least once during the three-year survey cycle.

Standard 3.2: Psychosocial Distress Screening

The Cancer Committee develops and implements a process to integrate and monitor on-site psychosocial distress screening and referral for the provision of psychosocial care . . . .

The psychosocial representative on the Cancer Committee (oncology social worker, clinical psychologist, or other mental health professional trained in the psychosocial aspects of cancer care) is required to oversee this activity and report to the Cancer Committee annually.

Timing of screening: Patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, and first visit with the medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or post chemotherapy follow-up visit. Preference is given to pivotal medical visits at times of greatest risk for distress, [emphasis added] such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy), and transitions off treatment.

Method: The mode of administration (such as patient questionnaire, clinician-administered questionnaire) is to be determined by the program.

Tools: Preference is given to standardized, validated instruments with established clinical cutoffs; however, facilities may use a measure of their choice.

The complete CoC Cancer Program Standards: Ensuring Patient-Centered Care  (2016 Edition) is available on the CoC website here.

Navigation Tools & Reports Can Support Compliance

Here are five tips for creating your navigation tools and reports so that they support CoC standard compliance:

  • Ensure that the fields in your tools are specific to the standard. Many navigation programs tend to over collect information that is not needed to be compliant with the standard, resulting in additional work for the staff and/or patient and possible confusion about what information needs to be reviewed at cancer committee.
  • Keep your documentation tools and reports simple. Be sure to define your documentation fields on your tools and reports; this will ensure that the navigators are collecting the information in a consistent manner.
  • Create evidenced-based tools. For compliance with the CoC standards, tools should be evidence based. For distress screening, examples include the NCCN psychosocial distress screening tool or the FACT (Functional Assessment of Cancer Therapy) tool.
  • Use your EHR or an Excel file. Since the navigation program needs to be reviewed at the cancer committees on a yearly basis, using your EHR or an Excel file makes it easy to aggregate information for these presentations.
  • Make the most of your Community Needs Assessment (CNA). Your CNA is essential because it helps identify your population of patients and their specific needs and barriers. The CNA can also be used to identify performance improvement activities for your program.  Further, it provides an excellent review for the navigators, as well as all cancer program support services, to more fully understand their patients.

Community Needs Assessment (CNA): A Valuable Resource

Cancer programs are not as familiar with creating Community Needs Assessments; however, there are great resources to help you identify the data you will need. For example, the information and data needed for your CNA can come from:   American Cancer Society Facts and Figures, American College of Surgeons Commission on Cancer, Academy of Medicine (formerly known as Institute of Medicine), the Centers for Disease Control and Prevention Cancer Data and Statistics, U.S. Census Bureau, State Health Department and Internal Revenue Service, and National Cancer Institute Surveillance Epidemiology and End Results.

As you develop your tools:  Make sure they work for YOU, and that you are NOT working for your tools.  


Guest blogger Tricia Strusowski, MS, RN, is a consultant with Oncology Solutions, LLC.

From Distress Screening to Solutions: Patient-Centered Support


By Don Jewler, Guest Blogger

The Edward and Marie Matthews Center for Cancer Care at the University Medical Center of Princeton at Plainsboro is a New Jersey cancer program with a tall vision to identify distress among their patients, no matter where they are within the organization, and refer them quickly to the help they need. The institution will be honored with a 2014 ACCC Innovator Award for the development of a distress tool that guides clinical staff in making timely and appropriate referrals.

“It’s been amazing how many different issues we have been able to solve for patients with the distress tool,” said Lori McMullen, RN, MSN, OCN, senior oncology nurse navigator. “One patient, for example, was having a really difficult time emotionally coping with cancer. With the distress tool, we could see that he was struggling with his diagnosis. Conversations were started. We were able to make sure he received the psychological help he needed, and that’s a beautiful thing.”

McMullen along with representatives from both outpatient and inpatient nursing staff developed the user-friendly distress tool, which uses a six-point Likert scale scoring system. Patients rank a number of concerns, including weight loss and nutrition, finances, sadness, anxiety, family, and, of course, coping with the disease. A line for “other” allows patients to write in whatever else is bothering them.

“In the outpatient setting, the distress tool is done on paper and entered electronically into each cancer patient’s electronic medical record. For our inpatients, we have worked with our IT department so that the tool is totally electronic” said McMullen.

Commission on Cancer Standard 3.2 (a 2012 standard that must be phased in for 2015) mandates that patients with cancer are offered screening for distress a minimum of one time per patient at a pivotal medical visit to be determined by the program. Some examples of a “pivotal medical visit” include time of diagnosis, pre-surgical and post-surgical visits, first visit with a medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post-chemotherapy follow-up visit.

“Here, the patient might take the distress tool three or four times during the treatment cycle,” said McMullen. “As clinicians we were worried that our patients would get tired, or even annoyed, that we keep asking them about their distress level, but we have found our patients are happy that we are concerned.” At the University Medical Center of Princeton at Plainsboro, patients are screened for distress in radiation oncology at the first nursing visit after simulation, in the outpatient infusion room at the first chemotherapy visit, at the physician’s office at week five or six if on treatment, at the breast health center after a treatment plan is developed, and at the end of radiation treatment.

McMullen makes sure that referrals to support services are made. She has been the champion for implementing the distress screening tool system-wide.

“It took time to put the new process into the daily routine,” she noted. “Inviting patients to share their problems may not fit into every physician’s time frame. Although it may not yet be second nature for everyone to work the distress tool into their schedule, with gentle reminding we are getting close to 100 percent compliance.”

McMullen will speak at ACCC’s 31st National Oncology Conference in San Diego, Calif. On Friday morning, October 10, 2014, she will discuss techniques and barriers for building and implementing a system-wide distress screening tool. Come listen.

ACCC members will recognize the byline of guest blogger, Don Jewler, former ACCC Communications Director. We coaxed Don out of retirement to contribute to ACCCBuzz.