Psychosocial Distress Screenings Essential to Patient-Centered Care

Mark Lazenby, PhD, APRN, FAPOS

Mark Lazenby, PhD, APRN, FAPOS

The American Psychosocial Oncology Society (APOS) partnered with Yale School of Nursing to launch the Screening for Psychosocial Distress Program in 2014. Oncology Nursing News caught up with Mark Lazenby, PhD, APRN, FAPOS, associate professor at Yale School of Nursing and the new president of APOS, at the 2015 World Congress on Psycho-Oncology in Washington, DC, to learn more about the training program and some of the most important considerations for clinicians who want to optimize their patient distress screenings.

What is the training process for the Psychosocial Distress Program, and how can interested cancer care professionals apply?

The Screening for Psychosocial Distress Program trains cancer care professionals from different disciplines to implement comprehensive distress screening. Comprehensive distress screening is not just a rapid screen. It includes evaluation of that screen, referral to psychosocial healthcare resources if needed, follow-up on referral, and documentation of this entire process and quality improvement.

We train people in dyads—two people from each institution over 2 years—to implement comprehensive distress screening. It’s great if the dyads are from different disciplines—a nurse and a social worker, or a nurse and a psychologist or a psychiatrist. The trainings occur at preconference workshops at APOS conferences over the 2 years. If applicants are accepted into the program, their workshops are free—so is their registration to the APOS conferences. In the workshops they learn how to implement comprehensive distress screening programs through live presentations, and then throughout the year we hold video conference calls to help them along the way.

Interested professionals can apply online at www.apos-society.org/screening. (Sidebar) They need to be sure that when they apply they get two support letters from key administrators from their institution. We’ve learned the hard way that if the people going through the program have support from key administrators, they’re more likely to be successful with implementation.

Is the NCCN distress thermometer still widely used as a screening tool?

The NCCN distress thermometer is one of the most widely used distress screening tools. It’s a simple thermometer with a 0-10 scale, and a patient selects the number that corresponds with their level of their distress over the past 7 days. It has with it an extended problem list that’s fairly complicated, but providers can simply use the thermometer without the problem list.

It doesn’t matter that a provider uses the distress thermometer, but it matters more that they use a validated scale. They can use scales that detect depression or anxiety or a whole host of symptoms. Many use the Edmonton symptom assessment system. It surveys basic physical symptoms as well as emotional symptoms and then a deeper evaluation can be done off the results. It matters more what works in an institution with the workflow and what can be really integrated into nursing assessment. The most important thing is that the institution has a policy in which they have a way to identify patients who may be distressed and to evaluate those patients for the sources of their distress. It can be done with any number of validated tools and worked seamlessly into the clinical assessment.

Are you hearing concerns about the time it takes to conduct distress screenings?

Some people do have concerns about time and concerns about just one more thing to do. Linda Carlson of the University of Calgary has shown in her work in Canada that it actually doesn’t necessarily increase time, though it is another step to take. What it does do is head off crises. So, it may take more time now, but in the long run it’s going to save time.

What are some of the broader practitioner challenges being spotlighted at this meeting?

The three broad issues that concern APOS scientists and the people who submit abstracts tend to align well with the accreditation standards for the American College of Surgeons Commission on Cancer: survivorship care plans, navigation, and distress screening. We see a lot of science being presented on distress screening, and there’s a lot of good science on the outcomes of distress screening, the importance of validated tools with established cutoff scores, and how to catch people who have chronic distress—maybe not acute, but who are in a smoldering phase that if we don’t catch them, it will become acute. The other large part of the science we’ve heard is the importance of opening communication between patient and provider.

Since you are at this conference with representatives from 49 different countries, would you say that you’ve found the concerns about psychosocial problems to be universal?

People in Africa, let’s just take sub-Saharan Africa, who live in poverty and have food needs still go into an existential crisis when they’re diagnosed with cancer. This crisis has been described since the 1980s with Avery Weisman, in which he called the first 100 days of a cancer diagnosis the “period of existential plight.” I don’t care where the patient lives. That patient hears the “c-word” and they may experience an existential crisis. And that’s the time that we need to provide good psychosocial care regardless of the patient’s living conditions. ____________________________________________________________________________

Applications Open for Psychosocial Distress Screening Program


The Screening for Psychosocial Distress Program trains cancer care providers on how to develop, implement, and maintain psychosocial screening programs to meet the Commission on Cancer’s new quality care standard.

Applications to attend are now being accepted. The deadline for submission is October 30, 2015.

Funded by a grant from the National Cancer Institute, the Screening for Psychosocial Distress Program is a joint project of Yale University School of Nursing and the American Psychosocial Oncology Society (APOS). With an international faculty of leading psychosocial cancer care professionals and researchers, the program trains two cancer care providers from one cancer care facility over 2 years.

The first year includes a beginning 1-day workshop held at the APOS conference in San Diego, March 3, 2016, and continues with four conference call teaching sessions throughout the year. The second year includes an advanced 1-day workshop and two conference-call teaching sessions throughout the year.

Funding for the Screening for Psychosocial Distress Program covers the APOS conference registration and allows for a stipend for each person toward covering the cost of attending the program. The program enrolls up to 18 cancer care facilities each year for a total of 36 participants. More information and an application can be found at: http://www.apos-society.org/screening.