Department of Supportive Care Medicine, Sheri & Les Biller Patient and Family Resource Center, City of Hope, Duarte, CA 91010-3000, USA.
Psychooncology. 2011 May;20(5):455-62. doi: 10.1002/pon.1930.
This commentary integrates successful screening implementation strategies applied in four institutions in the United States and the accumulated knowledge from international leaders about how to engage key professionals and administration in partnering to create a culture of screening.
As in clinical practice, it is first necessary to know the patient's story, potential resources and what motivates them to coordinated meaningful action. Introducing a comprehensive program of screening shares similarities with clinical care but also requires additional insights and an understanding of what motivates institutions to make resources available. Specific behaviors that are tailored to the values of particular professions and the institution are described to increase the likelihood of program uptake. Once key professionals and administration understand the value of screening and not before, a screening implementation plan is put into place.
Since the 1990s our screening programs have been successfully implemented in four settings: three NCI Designated Comprehensive Cancer Centers and one community hospital. It is estimated that more than 15,000 cancer outpatients have been screened for distress and cancer-related problems. These programs have demonstrated that biopsychosocial screening programs can be integrated into busy outpatient cancer clinics as part of standard clinical care.
Screening involves an intervention that impacts patients, clinical systems, the institution and staffing levels of psychosocial providers. Provision of scarce resources, active engagement of key professionals and administration will only occur if the stakeholders have a clear sense of the benefits for them. Implementing a screening program creates culture change and culture change not only takes time, but active engagement, patience and persistence.
本述评整合了美国 4 家机构实施成功筛查的策略，以及国际领导者在如何让关键专业人员和管理人员合作建立筛查文化方面积累的经验。
如同临床实践，首先必须了解患者的情况、潜在资源以及激励他们进行协调一致的有意义行动的因素。引入全面的筛查计划与临床护理有相似之处，但也需要更多的洞察力，以及了解是什么促使机构提供资源。为了增加计划采纳的可能性，描述了针对特定专业和机构价值观的具体行为。一旦关键专业人员和管理人员了解到筛查的价值，而非在此之前，就可以实施筛查实施计划。
自 20 世纪 90 年代以来，我们的筛查项目已成功在四个环境中实施：三个 NCI 指定的综合癌症中心和一家社区医院。据估计，已有超过 15000 名癌症门诊患者接受了困扰和癌症相关问题的筛查。这些项目表明，生物心理社会筛查项目可以作为标准临床护理的一部分，整合到繁忙的门诊癌症诊所中。
筛查涉及一种干预措施，会影响患者、临床系统、机构和心理社会提供者的人员配备水平。只有利益相关者清楚地了解对他们的好处，才会提供稀缺资源，让关键专业人员和管理人员积极参与。实施筛查计划会带来文化变革，而文化变革不仅需要时间，还需要积极参与、耐心和坚持。
