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CANCER PROGRAM STANDARDS: ENSURING PATIENT-CENTERED CARE
STANDARD 3.2
Psychosocial Distress Screening
Each calendar year, the cancer committee develops and implements a process to integrate
and monitor on-site psychosocial distress screening and referral for the provision of
psychosocial care.
DEFINITION AND REQUIREMENTS
To address the psychosocial issues experienced by patients with cancer, the 2007 report of the IOM, Cancer Care for
the Whole Patient: Meeting Psychosocial Health Needs, emphasizes the importance of screening patients for distress
and psychosocial health needs as a critical first step to providing high-quality cancer care. In addition, this report
emphasizes that all patients with distress need to be referred for the appropriate provision of care and that high-
quality psychosocial cancer care includes systematic follow-up and reevaluation.
Cancer programs must develop a process to incorporate the screening of distress into the standard care of oncology
patients. The process will identify psychological, social, financial, and behavioral issues that may interfere with a
patient’s treatment plan and adversely affect treatment outcomes, and provide patients identified with distress the
appropriate resources and/or referral for psychosocial needs.
PROCESS REQUIREMENTS
(a) Timing of Screening: All cancer patients must be screened for distress a minimum of one time at a pivotal
medical visit as determined by the program. The cancer committee defines one or more medical visits that are part
of a pivotal time for the distress screening process. Examples of a “pivotal medical visit” may include postsurgical
visits, first visit with a medical oncologist to discuss chemotherapy, routine visit with a radiation oncologist, or a post
chemotherapy follow-up visit. Preference could be given to pivotal medical visits at times of greatest risk for distress,
such as at time of diagnosis, transitions during treatment (such as from chemotherapy to radiation therapy), or
transitions off treatment.
(b) Method: The mode of administration (patient questionnaire or clinician-administered questionnaire) is to be
determined by the cancer committee, and may be tailored to the workflow of the practice. Medical staff, including
medical assistants, nurses, social workers, and physicians who administer or interpret the screening tool must be
properly trained.
The method process must address the sites of service where screenings occur, including at the CoC-accredited facility
and/or with the designated provider (such as offices of physicians) that are part of the program (medical oncologists
and/or radiation oncologists). The process developed by the cancer committee must include assessment and
treatment, or referral for treatment for the source of distress identified by the screening.
(c) Tools: The cancer committee selects and approves the screening tool to be administered to screen for current
distress. Preference should be given to standardized, validated instruments or tools with established clinical cutoffs.
The cancer committee determines the cutoff score used to identify distressed patients.
Questionnaires or forms that are distributed or returned by mail and/or phone interviews without discussion at a
medical visit do not meet the standard because this method does not allow for immediate attention for severe distress
or suicidal ideation, if patient reported, and does not allow for active dialogue with the patient. For those programs
utilizing a patient portal or electronic screening method, patients may complete the distress screening tool within 24
hours of the pivotal medical visit; however, screening results must be reviewed and discussed with patients face-to-
face at the visit.
(d) Assessment and Referr
al:
The distress screening results must be discussed with the patient at the medical visit. If there is clinical evidence of moderate or severe distress based on the results of the distress screening, a member of
the patient’s oncology team (physician, nurse, social worker, and/or psychologist) must assess the patient to identify
the psychological, behavioral, financial and/or social problems initiating the distress. This assessment will confirm the
presence of physical, psychological, social, spiritual, and financial support needs and identify the appropriate referrals
as needed. The process developed by the cancer committee includes the psychosocial, physician, spiritual, and mental
health, resources available to patients on-site or by referral.
Chapter 3: Continuum of Care
Services