Cancer Care Ontario's experience with implementation of routine physical and psychological symptom distress screening

Abstract

Routine physical and psychological distress screening is possible within regional cancer centres. Although considerable effort and investment is required, it is worthwhile as it helps create a culture that is more patient-centered.

Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: an online Delphi consensus process

“…Models of behaviour change and implementation science will guide strategies for system uptake. Implementation of routine distress screening programs in Canada and the US provides practical guidance for successful implementation [9,10,32] as the barriers and facilitators identified were similar to those identified in our pilot research [23]. Recommendations related to active engagement with local teams and identification of local champions [16,33 ] have informed our approach to local implementation.…”

Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center

“…Until PC programs are widely available, it would be helpful to develop clinical care pathways to address the generally low and unpredictable rates of PC referral. Under this system, cancer patients with various sentinel events, such as a poor performance status, severe symptom distress on screening, and brain metastases, would routinely be referred for PC [38]. Oncologists should also be educated and encouraged to make PC referrals, ideally by their "palliphilic" colleagues [29].…”

Integrating Psychosocial Care into Routine Cancer Care

“…[28][29][30][31] These efforts vary widely in the tools used to screen, the methods used to collect information from patients and deliver it to clinicians, and whether the information obtained from patients is present to clinicians with referral recommendations -all of which are features that limit the ability to draw conclusions from this literature. However, reason exists to question the value of solely implementing distress screening without also implementing referral recommendations for distressed patients.…”

“…2,33 Additional reports have provided more in-depth descriptions of efforts to implement distress screening and psychosocial referral and the acceptability and impact on processes of care in those efforts. [28][29][30][31][32]35 Work in this area would also benefit from published findings from rigorously designed, quality improvement projects designed to document the processes used to improve psychosocial care and the outcomes achieved, including the impact on patient quality of life. Such studies should also consider relevant conceptual frameworks such as the PRECEDE-PROCEED model, which focuses on identifying and influencing predisposing, enabling, and reinforcing factors for implementing changes.…”