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Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs
1,000 randomly selected members of the American Society of Clinical Oncology, 14 percent of respondents reported screening for psychosocial distress using a standardized tool. A third reported that they did not routinely screen for distress. Of the 65 percent that did routinely screen, 78 percent did so using some combination of asking direct questions (61 percent), such as “How are you coping?”, “Are you depressed?”, or “How do you feel?”; observing patients’ moods (57 percent); taking their history (53 percent); talking to family members (44 percent); or other methods. Similarly, of 15 organizations responding to a survey of 18 member institutions of NCCN, only 8 reported that they routinely screened for distress in at least some of their patients. Of these 8, 3 screened as part of a patient interview, 2 used a self-report measure, and 3 used both. Only 3 routinely screened all of their patients; the majority screened only certain groups of patients, such as those undergoing bone marrow transplantation or those with breast cancer (Jacobsen and Ransom, 2007).
Reasons given by individual oncologists for not screening include a lack of time, a perception of limited referral resources, a belief that patients are unwilling or resistant to discussing distress, and uncertainty about identifying and treating distress.4 Reasons given by member institutions of NCCN for not screening include screening not considered necessary or worthwhile (one institution), not enough resources to address those identified by a screener as needing care (one institution), and insufficient resources to both screen and address identified needs (one institution). The other institutions reported that they were currently in the process of pilot testing procedures for routine screening for distress (Jacobsen and Ransom, 2007).
The above concerns may not be justified. The experiences of those who have developed or now use screening tools show that screening need not take much time and that patients are willing to communicate their distress. Further, research shows that physicians’, nurses’, and other personnel’s individual assessments of the levels of stress experienced by patients or their family members are less accurate than a standardized instrument (Hegel et al., 2006). Although there remain some unresolved issues in screening that could be addressed by further research (see Chapter 8), the research and implementation examples reviewed below and in Chapter 5 demonstrate that screening can be both an effective and a feasible mechanism for identifying individuals with psychosocial health needs. The variation among existing validated screening instruments can facilitate the inclusion of screening in routine clinical practice by accommodating the differing interests and resources of various clinical sites. Patient Care Monitor (PCM), for example, is automated and part of a comprehensive patient assessment, care, and education system. Other instruments, such as the
Personal communication, William F. Pirl, MD, January 4, 2007.