Congress Abstracts 2005

63

IMPLEMENTING SYSTEMATIC SCREENING OF DISTRESS INTO ONCOLOGY NURSING PRACTICE. Susan Mazanec, MSN, RN, AOCN^®, Donna Kwilosz, PhD, and Wendy Miano, MSN, RN, AOCN^®, Ireland Cancer Center, University Hospitals of Cleveland, Cleveland, OH.

Although distress is common in patients undergoing cancer treatment, it often goes unreported by patients and unrecognized by nurses. The NCCN Practice Guidelines recommend use of a simple screening tool and problem list at consultation and at transition points during the cancer experience to assure that all patients are screened for distress. With this proactive approach, the oncology nurse plays a key role in managing low level distress and identifying patients with moderate to severe distress for early intervention.

The purpose of this project is to implement systematic screening of distress at the time of outpatient consultation at a NCI-designated Cancer Center. Management formed a task force to address the high levels of distress noted in anecdotes on patient satisfaction surveys and to outline the cancer center’s guideline for distress screening. The NCCN guideline stipulating a psychosocial referral for a distress score of 5 or above on a 0–10 scale was adopted.

Initial interventions included formation of a nursing and social work task force to implement the guidelines, assessment of current nursing practice, psychosocial resources identification, modification of the patient history form to include the distress scale, and design of a new referral form. Lectures and poster presentations for staff described the concept of distress, screening tool, management of low level distress, support services, referral process, and necessary practice change. A pilot project of integrating the distress screening tool into nursing practice was undertaken prior to the cancer center-wide rollout of the project on May 1, 2003.

Evaluation of compliance with the guideline is ongoing. A retrospective chart audit is conducted monthly to assess nursing documentation of referrals and social work documentation of patient contact. The task force meets monthly to review descriptive statistics from chart audits, obtain feedback from nurses and social workers, and outline strategies to address practice issues, documentation barriers, volume of referrals, and educational needs.

Integration of the NCCN distress screening tool into standard oncology nursing practice is a challenging and protracted process. Implementing these guidelines require careful planning, realistic assessment of nursing practice and social work resources, and monitoring of compliance.