Prior to 2014, the implementation of
evidence-based distress
screening in the healthcare setting was scarce. In 2014, to increase
objectivity in distress screening based on
qualitative data, the American Psychosocial Oncology Society (APOS) and
Yale School of Nursing (YSN) collaborated to publish the Screening for Psychosocial Distress program, outlining the five steps- Screen,
Evaluation,
Referral,
Follow-up and Documentation/Quality Improvement- to be carried out in psychosocial distress screening.
1. Screening The Distress Thermometer (DT) is an established self-assessment tool that invites patients to score their perceived level of distress during the previous week on a scale from
0 (no distress) to
10 (severe, intolerable distress). 39 different prompts classified as "
Practical", "
Family", "
Emotional", "
Spiritual", and "
Physical" categories are utilized to evaluate the wellbeing of patients experiencing psychosocial distress. An average rating of
>=4 points is regarded as significant, necessitating additional medical evaluation to determine the best course of
medical care.
2. Evaluation The recommended practice is to periodically assess ongoing and recovered cancer patients for anxiety and depressive symptoms during the course of their care, according to the
Pan-Canadian Screening, Assessment and Care guideline that is sponsored by the
American Society of Clinical Oncology (ASCO). The
Generalized Anxiety Disorder Scale can be used to evaluate symptoms of anxiety: a score of
0-4 implicates no symptoms,
5-9 implicates clement symptoms,
10-13 implicates moderate symptoms and
15-21 implicates severe symptoms.
3. Referral With reference to cancer patients in particular, in the event that typical management and treatment does not improve psychosocial distress outcomes, medical care professionals should provide patients with targeted referrals to
mental health and
social work institutions.
4. Follow-up Providing patients with follow up information,
discussion and
communication with their
healthcare providers enables for further
reevaluation upon the course of management or treatment that will be followed. Such communication also allows the provision of detailed patient-specific care.
5. Documentation/Quality Improvement All distress related patient information should be recorded in detail to reliably evaluate the course of the further action, according to the APOS Guidelines. == Distress Management (DM) ==