Distress Screening in Cancer: Dissemination and Implementation Research

Despite advances in cancer prevention, detection, and treatment in the United States, a full range of biomedical and psychosocial services is not available to all persons diagnosed with cancer (Institute of Medicine, 2008). Changes and restrictions in US health care delivery systems limit oncology social workers’ time, resources, and abilities to respond to the varied needs of a diverse and growing cancer patient population. In response to these short-comings and inequities, the American College of Surgeons (ACoS) Commission on Cancer has mandated the implementation of psychosocial distress screening for all cancer patients treated in approximately 1,500 ACoS-accredited facilities in the US by 2015. This mandate places oncology social workers at the forefront of developing and implementing procedures for distress screening, as it obligates the “psychosocial representative on an institution’s cancer committee to oversee this activity and report to the cancer committee annually” (Commission on Cancer, 2012, p. 76).

Emerging research suggests that routine psychosocial screening may result in improvements in health outcomes and enhancements in cancer care, particularly for the most distressed and marginalized patients and families who may benefit from social work services. Yet, distress screening is not widely adopted and is fraught with challenges related to (1) implementation across various health care delivery systems, (2) selection of appropriate instruments to assess patient-reported outcomes, and (3) system capacity to respond to identified patient/family needs. Little is known about the effectiveness of “best practices” or about replicability in oncology care settings.

Via lecture, question and answer, and small group discussion formats, this workshop will (1) elicit issues related to the dissemination of evidence to support the implementation of distress screening, and (2) facilitate discussion on future research opportunities and needs related to distress screening implementation (implementation research).

Objective 1: Introduce the context for distress screening in cancer care. Presenters will provide an overview of the historical, social, and economic forces influencing the dissemination and implementation of distress screening.

Objective 2: Identify challenges to dissemination and implementation of distress screening. Presenters will offer empirical evidence documenting barriers, challenges, and successes reported by oncology social workers in their efforts to implement distress screening. In small group discussions, workshop participants will share their knowledge, experiences, and observations about social worker efforts to implement distress screening, best practice models, and evidence suggesting their potential efficacy.

Objective 3: Examine issues related to distress screening instrument selection. Presenters will facilitate a discussion on the psychometric components and cultural equivalence of existing screening instruments, and implications for instrument selection.

Objective 4: Discuss opportunities for dissemination and implementation research. Presenters will elaborate opportunities for future investigations of distress screening efficacy and implementation. Topics for group discussion will include opportunities for investigators to develop consensus on distress measures as part of the NCI-sponsored Grid-Enabled Measures Distress Screening Initiative (GEM-DS), and screening for distress and psychosocial care needs at end of treatment in conjunction with survivorship care planning.