Researchers implemented a distress screening tool for patients with cancer and evaluated its use in a study with 21 patients. The researchers recently described the tool and reported their findings in the Journal of the Advanced Practitioner in Oncology.

Cancer diagnosis and treatment can be sources of distress for patients with cancer, and distress can negatively impact treatment response and adherence, among other factors and outcomes related to cancer management. However, screening for patient distress is not universally performed. The researchers who conducted this quality improvement project set out to implement a web-based tool for standardized distress screening in patients with cancer.

The program is called the CancerSupportSource (CSS), and it was developed and evaluated by the Cancer Support Community. The researchers followed a Plan-Do-Study-Act approach for implementing the program based on questions related to the goal of the project, how improvement would be determined, and changes to make to facilitate improvement. In this study, participants were also asked to evaluate the usefulness of the CSS tool.

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Psychosocial, physical, and practical areas of distress can be screened in patients with cancer through the CSS, which includes 15 questions related to possible concerns. Answers use a numbered scale with 0 reflecting a lack of concern and 4 reflecting a very serious concern. Upon completion, a care plan and reports are generated for the patient and staff, including resources based on participants’ responses.

For the quality improvement project, the researchers included the CSS in patient intake interviews to assess administration and receptivity of the tool. Evidence of clinically significant depression could be flagged by the CSS to help guide discussion and possible referral for psychiatric intervention.

Initially, 21 patients were screened using the CSS for distress and for clinically significant depression. The mean total distress score was 22.14 (SD, 13.19) of a possible 60. Among these patients, 13 (62%) showed moderate to very serious responses to questions on the depression subscale, and 38% of screened respondents were considered at risk for clinically significant depression. A total of 18 respondents reported the tool was helpful, with 3 reported it was not.

“Although the focus of the screening was to identify distress, all the participants expressed the value of sharing their cancer journey in a safe and unhurried manner,” the researchers wrote in their report. Following evaluation of the program, the CSS became a standard of care at the affiliate of the Cancer Support Community involved in the study. During the year after the quality improvement project, the researchers reported that most incoming patients had undergone screening.

The researchers concluded the CSS tool used in this study was effective at helping to determine the psychosocial needs of participants. “This project suggests that the extent of distress experienced in a sample of cancer survivors is significant and warrants a systematic approach to screening and referral in the community setting,” the researchers wrote in their report.


Bush NJ, Goebel JR, Hardan-Khalil K, Matsumoto K. Using a quality improvement model to implement distress screening in a community cancer setting. J Adv Pract Oncol. 2020;11(8):825-834. doi:10.6004/jadpro.2020.11.8.3

This article originally appeared on Oncology Nurse Advisor