From Distress Screening to Solutions: Patient-Centered Support

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 31^st 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.

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.