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Responding to patients' needs

Financial concerns, worries about family, fears, sadness, frustration, anger and fatigue are among the emotional and psychosocial issues cancer patients often face in addition to those medical issues specific to their cancer diagnosis and treatment.
In fact attention to emotional and psychosocial support is an area Nova Scotia cancer patients identify as important and one that the cancer system can improve upon.

This insight, gleaned from national and provincial patient satisfaction surveys, in part, prompted the Canadian Partnership Against Cancer to develop the national screening for distress initiative.

Screening for Distress has since been identified as an accreditation standard and now is a standard of care for Nova Scotia. First pilot tested in this province in 2009, work is now underway to integrate screening for distress into routine cancer care across the province.

MarianneArabCCNS is working with health professionals in district health authorities across the province to help patients manage their psychosocial and practical challenges as well as the physical challenges associated with cancer,” said Dr. Janice Howes, Clinical Leader, Psychosocial Oncology for CCNS. We are doing this by helping health professionals integrate screening for distress and distress management as a standard of care in their practice.”

A key piece in changing practice and integrating screening for distress into routine care is working with cancer teams to ensure the screening process occurs at the right time for the patient and that it fits within the team’s workload and schedule.

The focus has been on working with teams in all districts to determine how they work and how best to integrate the screening tool. This involves enhancing their knowledge and how they manage the conversation with patients so that pressing issues can be dealt with in a timely manner. In some clinics, a highly experienced nurse is working with teams to help them with this change in practice.

Teams across the province are working toward screening 80 per cent of newly diagnosed cancer patients. Already some teams are approaching this target, while others are at an earlier stage of implementation. The target recognizes that some patients may choose not to complete the screening tool, some may be too distressed to complete the screening tool, and in some cases a clinic may simply be too busy to screen patients on a given day. The realities of meeting patients’ clinical needs is why the clinics at Capital Health, for example, have decided that they will screen all new patients sometime between their first and third clinic visit.

“Within a busy clinic environment, health professionals are under tremendous time constraints,” said Dr. Howes. “Learning how to effectively manage the therapeutic conversation with patients about their level of distress is essential to successful implementation of this new standard of care. One way to manage this is to ask the patient, ‘What concern is bothering you most today?’ The goal is to address the primary concern identified by the patient and when appropriate, refer the patient to another member of the care team.”

Any change in practice takes time and it is important to take the time necessary to work through the implications that the change will have.

“Time is the biggest concern we’ve heard from health professionals,” said Marianne Arab, Manager, Supportive Care, CCNS. “But, for the most part they find the tool important and useful in identifying patients’ needs and say it has resulted in more meaningful conversations with patients.”

Many Nova Scotia cancer patients receiving chemotherapy or radiotherapy have an initial screen following diagnosis at their start of treatment. In some districts patients are now being re-screened at the end of treatment.

Patients, for the most part, have responded positively to the new tool. Those who have been screened feel their concerns are being heard and addressed.

While screening for distress is still new as a standard of cancer care across Nova Scotia, its value is being recognized in the primary care sector. In fact, there are early discussions about using the screening for distress tool for primary care and expanding its use to other chronic disease groups.

We’ll keep you informed as the discussions unfold.

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The success of the implementation of screening for distress as a new standard of cancer care is the result of across-the-board support from Health Canada through the Canadian Partnership Against Cancer; Department of Health and Wellness, Cancer Care Nova Scotia, and health professionals, administrators, and patients from all district health authorities.