Oncology Social Workers' Attitudes Toward Implementing Distress Screening with Cancer Patients: A National Online Survey

Purpose: In 2015, a new policy mandates that institutions accredited with the Commission on Cancer (CoC) of the American College of Surgeons implement distress screening for all cancer patients. However, not all cancer patients experience distress, with some having higher levels of psychosocial distress than others. Implementation of a standard assessment could place a burden on the systems of care in cancer institutions. The purpose of this study is to understand the attitudes of healthcare professionals towards the new policy and to describe implications of implementing distress screening for all patients.  Social workers working in accredited cancer institutions now have a professional duty to engage in distress screening, and to recognize the psychosocial and spiritual issues that impact cancer patients and their families. They must implement a plan to address these needs, and connect patients with appropriate services.  More than ever, social workers are involved in addressing the gaps in services by identifying psychosocial problems and tackling social justice issues that impact cancer care, all of which challenge the traditional role of the oncology social worker.

Methods: This paper utilizes survey research methodology from oncology social workers examine attitudes about cancer patients unmet needs, and whether a universal policy for psychosocial distress screening could negatively impact oncology social workers’ ability to provide care.  We conducted a National Online Survey with social workers from the Association of Oncology Social Work to examine their attitudes and practice behaviors related to distress screening.  The analysis included structured questions and free text. 

Results: With a 41.5% response rate (n=465, N=1125), participants reported that distress screening is useful and acts as a proactive measure to anticipate issues during treatment and assists to address patients’ concerns before a crisis happens. The majority said that screening for distress was either extremely (47.3%) or very much (42.2%) important to them. Distress screening was described as a quick way to get information, especially because of the limited time available. While some patients may not want to be seen by a social worker, many underreport their distress and distress screening allows those most in need to be heard.  However, some oncology social workers felt that distress screening tools should not be implemented with every patient, especially if they resources to follow up on patients’ needs. 

Implications: It is important for social workers to be aware of the various psychosocial distress screening tools that are available. However, by screening every patient there is a danger that social workers become overwhelmed with all types of patient care needs, big and small.  While standard screening tools can quickly identify patients’ needs, they can also identify patients in crisis, those most in need of a social worker.  Oncology social workers can assist cancer patients and families as they begin treatment and embrace the changes that occur during treatment. Further attention is needed to develop clinical strategies that include distress screening, while improving the overall quality of cancer care.