Distress Screening in Oncology Leads to Better Doctor-Patient Relationships and Improved Outcomes


Key Points

  • Implementing a distress screening intervention resulted in increased confidence in identifying, assessing, and managing patient distress.
  • Health-care professionals at smaller community cancer centers reported greater person-centered awareness as compared to those at larger tertiary sites throughout the study
  • Participants at smaller sites also identified more benefits from the distress screening intervention relative to those at the larger sites.

As many as 60% of patients with cancer report distress following a cancer diagnosis, and this stress can have a significant impact on patients’ well-being, resulting in psychosocial problems, physical side effects, and dissatisfaction with their health care.

To examine the impact of distress on patients and health-care professionals, Linda Watson, PhD, RN, of CancerControl Alberta, Alberta Health Services, led the implementation of screening for distress as a new standard of care across 17 provincial cancer care sites. More than 250 health-care professionals across cancer care facilities in Alberta, Canada, participated in educational sessions and adopted this standard of practice. Dr. Watson and Rie Tamagawa, PhD, a senior researcher in provincial practices, found that health-care professionals who participated in this educational program and utilized screening for distress routinely reported improved confidence in detecting patient distress and increased awareness of the importance of a patient-centered approach to care.

The study is published in JNCCN – Journal of the National Comprehensive Cancer Network.

“Distress can be caused by a variety of issues, concerns, or symptoms, but how distress is experienced and what underlies a person’s distress is unique to each person and changes over time. [Screening for distress] helps clinicians identify distressed patients and their issues, concerns, or symptoms driving their distress. This project has demonstrated that through clinical review and targeted response to the patient priority issue, improved clinical outcomes and patient experiences can be achieved,” said Dr. Watson.

Study Details

For Dr. Watson’s quality improvement project, the screening for distress intervention was implemented as a standard of care at all cancer care facilities in Alberta over a 10-month period. health-care professionals at all sites completed educational sessions prior to implementation of this new practice. Health-care professionals also completed surveys before and after implementation.

Results of the project illustrated a significant increase in participants’ confidence in identifying, assessing, and managing distress, as well as their awareness of person-centered care principles following the implementation. Health-care professionals at smaller community cancer centers reported greater person-centered awareness as compared to those at larger tertiary sites throughout the study. Health-care professionals at those smaller sites identified more benefits from the distress screening intervention relative to health-care professionals at the larger sites.

Smaller vs Larger Cancer Centers

This variance, Dr. Tamagawa reports, is likely because smaller, more remote cancer centers have patient navigation as part of their model of care and physicians are treating multiple tumor types. These are likely to contribute to personable patient-provider relationships. The benefits of the distress screening intervention was more salient for health-care professionals taking care of multiple tumor types, suggesting that such intervention is well adopted by physicians who practice as generalist model of care. On the other hand, physicians from larger centers tend to be single-tumor specialists at hospitals that do not employ patient navigation programs—these participants reported lower awareness in person-centeredness in general, and the distress screening intervention potentially posed an additional workload. 

Prior to adequate distress screening training and with less time for patient relationship-building, physicians often lack confidence in their ability to identify and treat patient distress in a timely manner. The study highlighted that distress screening interventions can help build this confidence and awareness of person-centered care delivery regardless of the types of care facilities.

In Alberta, Dr. Watson shared, “We have found that utilizing a screening for distress tool that spans the physical, emotional, social, spiritual, practical, and informational domains has been helpful as it reflects the whole patient experience.  It has been our experience that using a tool that helps the patient to specify their particular area of concern facilitates meaningful interventions.”

“Patient distress has received little attention from clinicians, but can have a large impact on patient quality of life. As such, screening for distress will become increasingly important in clinical practices, so information on its implementation is useful for practitioners,” said Jimmie C. Holland, MD, Wayne R. Chapman Chair in Psychiatric Oncology, Memorial Sloan Kettering Cancer Center, and Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Distress Management.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.