Skip to main content
SpringerLink
Log in

Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned

  • Special Report
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Accreditation bodies in the USA, the UK, and Europe have mandated that jurisdictions regularly screen patients for distress. While these requirements have been in place for some time, recent reports suggest that facilities still struggle to overcome implementation barriers. In Canada, a Screening for Distress (the sixth vital sign) Initiative was implemented in eight cancer treatment facilities in seven provinces. With national support and coordination from the Canadian Partnership Against Cancer, the initiative’s primary goal was to provide timely and appropriate response to cancer patients’ distress to improve the patient experience. Patient experience is defined as the sum of an individual’s perceptions, expectations and interactions related to his or her health and care throughout the cancer journey (CPAC 2012). The implementation included the application of evidence-informed tools by trained health care professionals to identify distress, facilitate intervention or referral, and enhance collaboration among health care providers to meet patient needs. Implementations have expanded in these facilities since the launch of the initiative and the success of this programmatic approach in Canada may assist other jurisdictions with successful implementation of Screening for Distress (sixth vital sign).

Purpose and methods

Lesson learned from the Screening for Distress (sixth vital sign) initiative are described in this article to share the experiences of the earlier adopter facilities that may assist other cancer centres wishing to implement a similar program. A description of the intiative and the evaluation approach is included to provide the context for the chief lessons learned about the implementation and sustainability of a Screening for Distress (sixth vital sign) program.

Results

Key lessons about the considerations for effective implementation and sustainability of a Screening for Distress (sixth vital sign) program included the critical significance of an effective change management strategy, leadership, integration, customization, project management, and program evaluation. A number of important knowledge dissemination and exchange strategies were also identified and the importance of overall co-ordination was emphasized.

Conclusions

Cancer treatment centers in Canada have embraced the concept of a formal programmatic protocol for distress screening. The Screening for Distress (sixth vital sign) initiative built on early lessons, expanded to other facilities, and was reported to make a positive contribution to patient care. The distress screening model has a formal place in the cancer system. The lessons revealed through this evaluation are useful to other cancer centers planning a programmatic approach for distress screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bultz BD, Groff SL, Fitch M, Blais M-C, Howes J, Levy K, Mayer C (2011) Implementing screening for distress, the 6thvital sign: a Canadian strategy for changing practice. Psychooncology 20(5):463–469

    Article  Google Scholar 

  2. Carlson L, Bultz B (2003) Benefits of psychosocial oncology care: improved quality of life and medical cost offset. Health Quality Life Outcomes 1:8. https://doi.org/10.1186/1477-7525-1-8

    Article  Google Scholar 

  3. Carlson LE, Angen M, Cullum J et al (2004) High levels of untreated distress and fatigue in cancer patients. Br J Cancer 90:2297–2304. https://doi.org/10.1038/sj.bjc.6601887

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wen KY, Gustafson DH (2004) Needs assessment for cancer patients and their families. Health Qual Life Outcomes 2:11. https://doi.org/10.1186/1477-7525-2-11

    Article  PubMed  PubMed Central  Google Scholar 

  5. National Comprehensive Cancer Network (NCCN). (2010). Distress Management. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp Accessed 25 September 2017

  6. Bultz B, Carlson L (2006) Emotional distress: the sixth vital sign-future directions in cancer care. Psycho-Oncology 15:93–95. https://doi.org/10.1002/pon.1022

    Article  PubMed  Google Scholar 

  7. Jacobsen PB (2009) Promoting evidence-based psychosocial care for cancer patients. Psycho-Oncology 18(1):6–13. https://doi.org/10.1002/pon.1468

    Article  PubMed  Google Scholar 

  8. Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psycho-Oncology 19(1):19–28

    Article  Google Scholar 

  9. Accreditation Canada. (2008). Cancer care and oncology services standards. https://accreditation.ca/review-our-standards. Accessed 25 September 2017

  10. Fitch MI, Howell D, McLeod D, Green E (2012) Screening for Distress: responding is a critical function for oncology nurses. Can Oncol Nurs J 22(1):12–20

    Article  Google Scholar 

  11. Swerissen H, Duckett SJ, Daly J, Bergen K, Marshall S, Borthwick C, Crisp B (2001) Health promotion and evaluation—a programmatic approach. Health Promot J Austr 11(1):1–28

    Google Scholar 

  12. Walters, H. (2012). Guidance note for the programmatic approach of the ICCO alliance. http://wwwslidesharenet/compartuser/guidance-note-for-the-programmatic-approach-version-31122011 Accessed 25 September 2017

  13. Basch EM, Deal AM, Dueck AC et al Overall survival results of a randomized trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment [published online first June 4, 2017]. JAMA. https://doi.org/10.1001/jama.2017.715

  14. Cleeland SC, Wang SW, Mendoza TR, Wright SL, Berry MD, Malveaux D et al (2011) Automated symptom alerts reduce post operative Stmprom severity after cancer surgery: a randomized controlled clinical trial. J Clin Oncol 29(8):994–1000

    Article  Google Scholar 

  15. Mooney, K.H., Beck, S.L, Wong, B., Dunson, W., Wujcik, D., Whisenant, M., & Donaldson, S. (2017). Automated home monitoring and management of patient-reported symptoms during chemotherapy: results of the symptom care at home RCT. Cancer Medicine, 6(3), 537-546. DOI: 10 1002/cam4.1002

  16. Carpenter JS, Rawls S, Porter J, Schmidt K, Tornatta J, Ojewole F et al (2008) Oncology outpatient and provider rresponses to a computerized symptpom assessment system. Oncol Nurs Forum 35(4):661–669. https://doi.org/10.1188/08/ONF.661-669

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yount SE, Rothrock N, Bass M, Beaumont JL, Pach D, Lad T, Patel J, Corona M, Weiland R, del Ciello K, Cella D (2014) A randomized trial of weekly symptom telemonitoring in advanced lung cancer. J Pain Symptom Management 47(6):973–989. https://doi.org/10.1016/j.jpainsymman,2013.07.013

    Article  Google Scholar 

  18. Wang XS, Shi Q, Williams L, Komaki R, Gomez DR, Lin H et al (2016) Prospective study of patient-reported symptom burden in patients with non-small cell lung cancer undergoiong proton or proton chemoradiation therapy. J Pain Symptom Manag 51(5):832–838. https://doi.org/10.1016/j.jpainsymman.2015.12.316

    Article  Google Scholar 

  19. Boyce MB, Browne JP (2013) Does providing feedback on patient-reported outcomes to health care professionals result in better outcomes for patients? A systematic review. Qual Life Res 22(9):226–278. https://doi.org/10.1007/s11136-013-0390-0

    Article  Google Scholar 

  20. International Psychosocial-Oncology Society, Abstracts from the 19th World Congress Psycho-Social Oncology (26) Supp. 3, August 2017. http://www.ipos2017.com/files/content/downloads/IPOS2017_Abstractbook.pdf Accessed 25 September 2017

  21. Boyce MB, Browne JP, Greenhlagh J (2014) The experiences of professionals using information from patient-reported outcomes measures to improve the quality of health care. A systematic review of qualitative research. BMJ Qual Saf 23(6):508–518. https://doi.org/10.1136/bmjqs-2013-002524

    Article  Google Scholar 

  22. Canadian Partnership Against Cancer (2012). Screening for distress, The 6th vital sign: a guide to implementing best practices in person-centred care. https://content.cancerview.ca/download/cv/treatment_and_support/supportive_care/documents/guideimplementsfdpdf?attachment=0 Accessed 25 September 2017

  23. Canadian Association of Psychosocial Oncology, Clinical Practice Guidelines, 2009 to 2012. https://oncology.capo.ca/public/#clinical-guidelines Accessed 25 September 2017

  24. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton symptom assessment system (ESAS): a simple method of assessment of palliative patients. J Palliate Care 7:6–9

    CAS  Google Scholar 

  25. Canadian Association of Psychosocial Oncology, Interprofessional Psychosocial Oncology Distant Education, Screening for Distress Education Program https://www.capo.ca/ipode-project/screening-for-distress/ Accessed 25 September 2017

  26. Hayes, John (2014) Theory and practice of change management, Fourth Edition Palgrave Macmillan, New York

  27. Canadian Partnership Against Cancer (2017). Person-Centred perspective indicators in Canada, A Reference Report, 51–56

  28. Canadian Partnership Against Cancer (2017). System performance, Screening for Distress Indicator http://wwwsystemperformanceca/cancer-control-domain/person-centred-perspective/screening-for-distress Accessed 25 September 2017

  29. PricewaterhouseCoopers Canada (July 2011). Canadian partnership against cancer, cancer patient journey: evaluation of screening for distress and survivorship initiatives. Internal report

Download references

Acknowledgements

Production of the Screening for Distress (sixth vital sign) initiative was made possible through financial support from Health Canada through the Canadian Partnership Against Cancer. Both Dr. Fitch and Ms. Nicoll were staff with the Canadian Partnership Against Cancer, and Dr. Ashbury was consulting to the partnership on the evaluation of Screening for Distress (sixth vital sign). The authors wish to thank PricewaterhouseCoopers Canada for providing resources to facilitate the early phase of research for this project. The authors also wish to thank Ms. Tina Sahay, MHSc, for her earlier contributions to support the original evaluation of the Screening for Distress (sixth vital sign) initiative. Finally, we acknowledge the time, effort, and insights of those whom we interviewed and key informants to facilitate our understanding of the initiative in their respective jurisdictions.

Author information

Authors and Affiliations

  1. Cancer Journey Advisory Group, Canadian Partnership Against Cancer, Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

    Margaret I. Fitch

  2. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Fred Ashbury

  3. Department of Oncology, University of Calgary, Calgary, Canada

    Fred Ashbury

  4. PICEPS Consultants, Inc., Whitby, Canada

    Fred Ashbury

  5. Cancer Journey Advisory Group, Canadian Partnership Against Cancer, Toronto, Canada

    Irene Nicoll

Authors
  1. Margaret I. Fitch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fred Ashbury
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Irene Nicoll
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margaret I. Fitch.

Ethics declarations

Conflicts of interest

Margaret Fitch received renumeration as a consultant from the Canadian Partnership Against Cancer in relation to this work.

Irene Nicoll received renumeration as a staff member from the Canadian Partnership Against Cancer in relation to this work.

Fred Ashbury received renumeration as a consultant from the Canadian Partnership Against Cancer in relation to this work.

Data can be accessed if required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fitch, M.I., Ashbury, F. & Nicoll, I. Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned. Support Care Cancer 26, 4011–4020 (2018). https://doi.org/10.1007/s00520-018-4278-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4278-y

Keywords

Search

Navigation