Der Onkologe

, Volume 22, Issue 9, pp 622–630

Erfassung psychosozialer Belastungen in der onkologischen Routine-Praxis

Leitthema
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Zusammenfassung

Hintergrund

Krebserkrankungen bringen eine Vielzahl von körperlichen, seelischen und sozialen Belastungen mit sich. Das onkologische Team ist herausgefordert, den Menschen in seiner Ganzheit zu begleiten. Die Integration der psychosozialen Betreuung in das Behandlungssetting wird heute als Standard bezeichnet. Dies bedingt eine Screening-Methode im onkologischen Team, damit Patienten mit Bedarf an Betreuung identifiziert werden können.

Ziel

Ziel ist die Beschreibung des Distress-Screenings als Teil des Distress-Managements in der onkologischen Routinepraxis, mit Diskussion und Anregungen zur Implementierung.

Material und Methoden

Selektive Literaturübersicht PubMed. Auseinandersetzung mit Forschungsergebnissen und Reflektion von Beobachtungen aus der Praxis.

Ergebnisse

Obwohl die psychosoziale Betreuung heute als Teil der onkologischen Routineversorgung bezeichnet wird, folgt die Umsetzung der systematischen Erfassung von Belastungen nur zögerlich. Das validierte Distress-Thermometer (in deutscher Sprache) des National Comprehensive Cancer Networks eignet sich zur Selbsterfassung der Belastungen. Die Implementierung eines Screenings erfordert die Klärung, wer, wann, bei wem, wie und wie oft das Screening vornimmt und was die Antworten auf die Resultate sein können. Die Machbarkeit der Integration des Distress-Screenings in der Praxis wurde bestätigt. Die Kommunikation wird dadurch gefördert und die Rolle der Pflegenden bereichert.

Schlussfolgerung

Die Screening-Methode zur Identifikation von Personen mit hoher Belastung mittels Distress-Thermometer in der onkologischen Routinepraxis scheint machbar und wirksam. Die Implementierung der Methode ist anspruchsvoll. Das Psychotherapie-Team kann seine Ressourcen für die Patienten mit hoher Belastung einsetzen, während die Mehrheit der Patienten mit moderater Belastung durch das onkologische Team betreut wird.

Schlüsselwörter

Distress Distress-Thermometer Distress-Screening Psychoonkologie Implementierung 

Identifying psychosocial distress in routine practice

Abstract

Background

Cancer and its treatment are associated with a large variety of physical, psychological and social distress. The oncology team is challenged to provide patients with much more than medical and physical care. Although the integration of psychosocial care is seen as a standard today, the systematic assessment of psychosocial distress still seems to be neglected.

Objective

To describe distress screening as part of distress management in routine oncology practice and to discuss benefits and challenges of implementation.

Material and methods

A selective literature review was conducted in PubMed. Research findings were critically explored and observations from clinical practice and research were reflected.

Results

Although integration of psychosocial care in routine oncology practice is considered as standard today, the implementation of a systematic assessment of distress follows only hesitantly. The use of the distress thermometer (in German) developed by the National Comprehensive Cancer Network is recommended for screening. The implementation of screening as a program requires clarification on who, when, for whom, how and how often screening should take place and what the response to the results should be. The feasibility of a distress screening program in clinical practice was confirmed. It has been found to improve communication and to enrich the role of oncology nurses.

Conclusion

Screening for high degrees of distress in patients with cancer has been shown to be feasible and effective. For the oncology team the implementation remains challenging. The psycho-therapeutical team can direct its resources towards persons identified as having severe distress, while the majority of patients with moderate degrees of distress are cared for by the oncology team.

Keywords

Distress Distress thermometer Distress screening Psycho-oncology Implementation 

Literatur

  1. 1.
    Admiraal JM, Nuenen FM van, Burgerhof JG (2016) Cancer patients’ referral wish: effects of distress, problems, socio-demographic and illness-related variables and social support sufficiency. Psychooncology doi:10.1002/pon.4067PubMedGoogle Scholar
  2. 2.
    American Society of Clinical Oncology (ASCO) http://www.nccn.org/physician-gls/index.html. Zugegriffen: 30. März 2016
  3. 3.
    Botti M, Endacott R, Watts R et al (2006) Barriers in providing psychosocial support for patients with cancer. Cancer Nurs 29(4):309–316CrossRefPubMedGoogle Scholar
  4. 4.
    Bulli F, Miccinesi G, Maruelli A et al (2009) The measure of psychological distress in cancer patients: the use of distress thermometer in the oncological rehabilitation center of florence. Support Care Cancer 17:771–779CrossRefPubMedGoogle Scholar
  5. 5.
    Bultz BD, Groff SL, Fitsch M et al (2011) Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice. Psychooncology 20(5):463–469CrossRefPubMedGoogle Scholar
  6. 6.
    Carlson LE, Bultz BD (2003) Cancer distress screening. Needs models and methods. J Psychosom Res 55:403–405CrossRefPubMedGoogle Scholar
  7. 7.
    Chiang AC, Buia AS, Corjulo D et al (2015) Incorporating patient-reported outcomes to improve emotional distress screening and assessment in a ambulatory oncology setting. J Oncol Pract 11(3):219–222CrossRefPubMedGoogle Scholar
  8. 8.
    Dinkel A, Berg P, Pirker C et al (2010) Routine psychosocial distress screening in radiotherapy: implementation and evaluation of a computerised procedure. Br J Cancer 103(10):1489–1495CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Donovan KA, Grassi L, McGinty HL, Jacobson PB (2014) Validation of the distress thermometer worldwide: state of the science. Psychooncology 23(3):241–250CrossRefPubMedGoogle Scholar
  10. 10.
    Fitsch M (2011) Screening for distress: a role for oncology nursing. Curr Opin Oncol 23:331–337CrossRefGoogle Scholar
  11. 11.
    Giese-Davis J, Waller A, Carlson LE et al (2012) Screening for distress, the 6th vital sign: common problems in cancer outpatients over one year in usual care: associations with marital status, sex and age. BMC Cancer 12:441CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Herschbach P, Keller M, Knight L et al (2004) Psychological problems of cancer patients: a cancer distress screening with a cancer specific questionnaire. Br J Cancer 91:504–5011CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hess C, Singer M, Aliasgher K et al (2015) Optimal frequency of psychosocial distress screening in radiation oncology. J Oncol Pract 4:298–302CrossRefGoogle Scholar
  14. 14.
    Holland JC, Anderson B, Breitbart WS et al (2013) Distress management. J Natl Compr Canc Netw 1:190–209Google Scholar
  15. 15.
    Hollingworth W, Metcalfe C, Mancero S et al (2013) Are needs assessments cost effective in reducing distress among patients with cancer? A randomised controlled trial using the distress thermometer and problem list. J Clin Oncol 31(29):3631–3638CrossRefPubMedGoogle Scholar
  16. 16.
    Hughes KL, Sargent H, Hawkes AL (2011) Acceptability of the distress thermometer and problem list to community-based telephone cancer helpline operators and to cancer patients and carers. BMC Cancer 11:46CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Lazenby M, Hui T, Pasacreta N et al (2015) The five steps of comprehensive psychosocial distress screening. Curr Oncol Rep 17:22 doi:10.1007/s11912-015-0447-zCrossRefGoogle Scholar
  18. 18.
    Lynch J, Goodhart F, Saunders Y, O’Connor SJ (2011) Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient distress thermometer. Support Care Cancer 19:193–202CrossRefGoogle Scholar
  19. 19.
    Ma X, Zhong W, Wang F et al (2014) The diagnostic role of a short screening tool-the distress thermometer: a meta-analysis. Support Care Cancer 22:1741–1755CrossRefPubMedGoogle Scholar
  20. 20.
    Mehnert A, Müller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress Thermometers. Z Psychiatr Psychol Psychother 54(3):213–223Google Scholar
  21. 21.
    Mitchel A, Lord K, Slattery J et al (2012) How feasible is implementation of distress screening by cancer clinicians in routine clinical care? Cancer 118(24):6260–6269CrossRefGoogle Scholar
  22. 22.
    NCCN Guidelines Version 3.2015. Distress Management. http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf. Zugegriffen: 30. März 2016
  23. 23.
    Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial intervention for depression, anxiety and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36:13–34CrossRefPubMedGoogle Scholar
  24. 24.
    Passalaqua R, Annunziata M, Borreani C et al (2016) Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare projedt). Support Care Cancer 24(1):147–155CrossRefGoogle Scholar
  25. 25.
    Pirl WF, Muriel A, Hwang V et al (2007) Screening for psychosocial distress: a national survey of oncologists. J Support Oncol 5:449–404Google Scholar
  26. 26.
    Razavi D, Stiefel F et al (1999) Psychiatric disorders in cancer patients. In: Klastersky J, Schimpf S, Senn HJ (Hrsg) Supportive Care in Cancer. A Handbook for Oncologists, 2. Aufl. Marcel Dekker, New York, S 345–366CrossRefGoogle Scholar
  27. 27.
    Roli A, Borreani C, Bosisio M et al (2016) The OECI model : the experience of INT Milan with a focus on the integration of psycho-oncology Support. Tumori 29(Suppl):101Google Scholar
  28. 28.
    Schweizerische Gesellschaft für Senologie, Krebsliga Schweiz (2015) Qualitätskriterien für die Zertifizierung von Brustzentren. http://assets.krebsliga.ch/downloads/qualitatskriterien_d.pdf. Zugegriffen: 31. März 2016Google Scholar
  29. 29.
    S3-Leitlinie für die Diagnostik, Therapie und Nachsorge des Mammakarzinoms 2015. AWMF-Register-Nummer: 032–045OL, Kurzversion 3.0. http://www.awmf.org/uploads/tx_szleitlinien/032-045OL_k_S3__Brustkrebs. Zugegriffen: 31. März 2016
  30. 30.
    Wagner LI, Spiegel D, Pearman T (2013) Using the science of psychological care to implement the new american college of surgeons commission on cancer distress screening standard. J Natl Compr Canc Netw 11(2):214–221PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.OnkologiepflegeTumor- und Brustzentrum ZeTuPSt. GallenSchweiz
  2. 2.Florence Nightingale Faculty of Nursing and MidwiferyKing’s College LondonLondonUK

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