How feasible is implementation of distress screening by cancer clinicians in routine clinical care?

Cancer. 2012 Dec 15;118(24):6260-9. doi: 10.1002/cncr.27648. Epub 2012 Jun 6.


Background: There is considerable uncertainty regarding the acceptability of routine distress screening.

Methods: In an unfunded implementation study, the authors asked 50 clinicians (chemotherapy nurses and treatment radiographers/radiation technologists) to implement a screening program for distress as part of routine care and to record their feedback after each clinical encounter. In total, 379 patients were screened using a simple paper-and-pencil versions of distress thermometer and the emotion thermometer (ET).

Results: Across all screening applications, clinicians believed that screening was useful during 43% of assessments and was not useful during 35.9% of assessments, and they were unsure or neutral in 21.1% of assessments. The application of the screening program assisted staff in changing their clinical opinion after 41.9% of assessments, and clinicians believed that the screening program helped with communication in >50% of assessments. However, 37.5% believed that screening was impractical for routine use, and more chemotherapy nurses than radiographers rated the screening program as "not useful." On multivariate analysis, 3 variables were associated with high staff satisfaction with screening, namely, receipt of prior training, talking with the patient about psychosocial issues, and improved detection of psychological problems. A favorable perception of screening also was linked to a change in clinical opinion.

Conclusions: Opinions of cancer clinicians regarding routine distress screening were mixed: Approximately 33% considered screening not useful/impractical, whereas >50%n believed promoted good communication and/or helped with recognition. Clinicians who were more positive about screening gained greater benefits from screening in terms of communication and recognition.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Communication
  • Female
  • Follow-Up Studies
  • Health Plan Implementation*
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Patient Care Team
  • Practice Patterns, Physicians'*
  • Prognosis
  • Quality of Life*
  • Stress, Psychological / diagnosis*
  • Stress, Psychological / etiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Survival Rate
  • Young Adult