Course Summary
1.0 Introduction
Medicine has come a long way in treating cancer and increasing survival rates. While health care providers routinely address the physical health needs of cancer survivors, their psychosocial concerns associated with cancer are often overlooked. Some patients don’t volunteer this information to their providers, as they may have reservations about discussing mental health.
Furthermore, many health care providers are not assessing their patient’s psychosocial concerns. In fact, a third or fewer cancer survivors have had a discussion initiated by their doctors about psychosocial needs and concerns, and fewer are receiving treatment for distress (Buchanan, 2016).
Caring for both the mental and physical health needs of patients is critical for better medical outcomes. Patients’ mental health concern can impact their ability to adhere to medical care and surveillance recommendations, not to mention their overall quality of life. Addressing their concerns can lead to better outcomes such as; fewer physical symptoms, improved functioning, and better treatment results. Distress screening helps providers identify their patients’ distress symptoms and distress level, and guide them to appropriate care.
When implementing routine distress screening for cancer survivors, it’s important to use established standards and practice guidelines. You can reference these standards in the Resources Section.
2.0 Psychosocial Concerns & Cancer Survivorship
Defining Distress
Distress in the context of cancer survivors is defined as: “a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment.” (NCCN, 2018)
Distress is on a continuum, ranging from mild to severe, and can include symptoms such as fear, sadness, anxiety, depression, panic, and stress reactions related to post-traumatic stress disorder. When combined with post-treatment neurocognitive challenges, financial issues, lack of support system, and challenges at work, any of these distress symptoms can negatively impact a patient's overall being and health outcomes. Keep in mind that psychosocial concerns will differ depending on a number of factors, like a patient's age, and medical and psychological history.
Screenings & Referrals
Distress screening is a useful way to start the conversation about your patient’s experience and concerns. When you're choosing screening tools, it’s critical that they're standardized and validated, have appropriate cut-off scores, and are appropriate for your patients and your setting. And while screening results are NOT diagnoses, they DO provide useful information, help you decide when to monitor and when to intervene, and give you an "in" to discuss the patient's experience. You can find examples of screening tools in the Resources Section.
The insight you gain from a distress screening can also help you suggest appropriate referral needs. Your patients may have different referral needs depending on their level of experienced distress. For instance, patients with minimal distress may only need psychoeducation or patient-patient support. Whereas patients with severe distress may benefit from crisis intervention, professional lead support group, or psychotherapy and/or pharmacologic treatment.
Remember to work with your patients to find what works best for them. You and your team also should be prepared to address insurance concerns and have resources available to explain different referral options.
3.0 Talking with Your Patients
When discussing distress screenings with you patients, there are a few communication techniques you can use to help your patients feel more comfortable. They can also help you to make effective referrals and keep the discussion concise to make good use of time.
Open Ended Questions
Use open ended questions to discuss the screening results and elicit more details about Ellen’s experience.
Provider: How has your mood been lately?
Ask-Tell-Ask
To share information respectfully, try first asking for permission or asking what the patient already knows. Many patients are quite knowledgeable about their own conditions. Then, you can correct any misconceptions and share anything new, then follow up with a question to hear her reaction. details about Ellen’s experience.
Provider: Can I explain the distress screening you filled out in the waiting room? (Ask)
Patient: Um… I guess.
Provider: We have everyone fill out the distress screening form as a routine part of patient in-take, to help us identify how our patients are feeling and functioning. This allows us to make recommendations to help our patients live happier, healthier lives. We spend a lot of time caring for our patient’s physical health, but caring for their mental health is equally important. (Tell)
Provider: How do you feel about that? (Ask)
Patient: Oh, that’s- okay.
Summarize & Reflect
Summarizing what a patient says and reflecting it back to them without judgment helps patients process their thoughts and feel heard.
Provider: You have a lot to think about, between difficulties with memory and attention at work, new family dynamics, and still adjusting to life with a colostomy bag.
Patient: Huh... I guess I... I’ve never really laid it out there that way before.
Normalize
Normalizing that others have gone through the same thing and found recovery will help patients feel capable of change.
Provider: It’s common for patients to have difficulty adjusting to life after treatment I hear that all the time. Patients who’ve been diagnosed with and treated for cancer will report having trouble sleeping, trouble staying focused, and... experiencing changes with their families and other relationships.
Share Actionable Information
Sharing actionable information makes patients feel capable of change and increase the likelihood that they will follow up on their referral.
Provider: Could I give you a referral for further consultation with our mental health specialist? Our specialist could help you with relaxation techniques and behavioral strategies that could help you with everything we discussed. You have the option to schedule that consultation now while you’re already here. That way you don’t have to take time away from your week.
Citations
i. Buchanan, N. (2016). Alleviate Cancer Survivor Distress: Screening and Psychosocial Care. CDC Expert Commentary. https://www.medscape.com/ viewarticle/864507
ii. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. (2018). Version 2.2018 Distress Management. NCCN.org