ICCN 17

Screening for Distress

Dr Margaret Fitch – Odette Cancer Center, Toronto, Canada




Can you tell us about Screening for Distress?

It is a national project and it’s something that we are trying to start in every single province in the country. The idea emerged from knowing that cancer patients experience distress; anybody who is facing a diagnosis is going to be upset and that upset may range from normal fears or worries or concerns that anybody would have during illness but it may extend to become so incapacitating that people have difficulty solving problems, they have difficulty coping with what’s happening. In the cancer system at the moment we tend not to pay as much attention to distress, we focus on identifying tumours, on curing the cancer, curing the disease but that disease and that treatment has such an impact, the person has so many things that they’re trying to deal with. So what we’re trying to do is set up a concrete strategy that would actually help clinicians have good conversations with patients about their emotional distress. The tool is something that is on a touch screen and the patient just answers a few questions and that will then produce the patient’s perspective, or the patient’s idea, about what’s going on for them and that becomes the starting point for a conversation. We’re hoping that that conversation then would be very meaningful and focus on what’s important to the patient.

Where is this available?

At the moment it’s only available in certain centres that have agreed to start the project. Most of it is happening in ambulatory settings so not so much in hospital just at the moment.

How have they been received by healthcare professionals?

Once they get used to it and once they have some comfort in terms of responding to the results of the questionnaire, they see that the conversations are different. They are able to really understand in a different way than currently happens what’s important to patients. That makes the conversation different, that makes the plan of care different and patients themselves say their satisfaction is much different, they feel that they’re listened to, they feel they are attended to, that their concerns are really important and their concerns are driving the plan of care.

How do you address the needs of the healthcare professionals that have been identified?

That’s a very important question to ask because without education, without adequate preparation, then there can be some discomfort in responding to some of the concerns. I think particularly having conversations about sexuality, having conversations about spirituality, those are topic areas that some of the clinicians don’t feel as comfortable having conversations about. So we have to make sure that they have the appropriate kind of education and the appropriate kind of information so they can have meaningful conversations.

Is the screening tool for use by the nurses as well as the medical team?

Yes, it actually can be used by any member of the cancer care team, so social workers, nutritionists, depending on who is actually caring for the person at a particular point in time.

Is the tool used more than once with each patient?

We actually have a patient start using it as soon as they come in to a cancer centre and then with every visit we would ask them to complete the tool again. It only takes 2-3 minutes, it’s very quick and the printout that comes from in the kiosk actually gives a summary of what the patient has actually answered. That then goes directly with the patient to the appointment with the clinician.

What else would you like to share about the project?

It’s a concrete intentional strategy to try to move us towards a person-centred care system. That person-centred care system, we talk about it, it sounds wonderful when you talk about it but it’s a challenge to figure out what you actually need to do in a behavioural kind of way to actually achieve that goal of a person-centred system. So we’ve tried this concrete strategy and I think it’s very helpful in terms of moving us forward changing the culture of cancer care so that it doesn’t become only a tumour-centred system but it’s a person-centred system.

Who designed the project?

It was an inter-professional team who actually put the ideas together and it was a team that was very committed to the idea of having the patient’s perspective guide the conversations and guide the plans of care.

Was it more easily accepted having been developed by a multi-disciplinary team?

I would say the plan was more comprehensive because we had so many different perspectives coming to bear.

What about patient engagement?

Their perspective is brought forward but I think the caveat in the whole situation is they have to have a response that’s meaningful. So if they fill out something like a questionnaire and nobody does anything with it then that is not going to be a satisfying experience. But as long as the clinicians are responding, are responding in meaningful ways, then it is moving us towards that sense where patients say, “Somebody heard what was important to me.”

Where do you see the project in the future?

In Canada we’ve actually reached the point where it’s a standard of care in our accreditation system. So I’m hoping that from the nine centres that are currently in our demonstration project that will evolve to become every cancer centre and it will eventually be in hospital as well.