Department of Psychosocial Resources, Tom Baker Cancer Centre, Holy Cross Site, Alberta Health Services, Cancer Care, Calgary, AB, Canada.
Psychooncology. 2011 May;20(5):463-9. doi: 10.1002/pon.1932.
Distress is prevalent among cancer patients at all stages of illness and has been endorsed as the 6th Vital Sign in cancer care. Despite its prevalence, and calls to be monitored, few cancer programs are Screening for Distress in a standardized manner. In this paper, the implementation strategy employed in Canada to change practice by integrating Screening for Distress in routine care is described.
The process from inception of the concept of distress to the implementation of Screening for Distress is discussed. Pioneering work pertinent in laying the foundation for Screening for Distress as a National initiative is highlighted. Additionally, the experience of four jurisdictions currently Screening for Distress is utilized to demonstrate steps to successful implementation and strategies for overcoming challenges.
Integrating Screening for Distress into practice requires endorsements from key stakeholders, developing and disseminating national recommendations and guidelines, and utilizing a coordinated and standardized method focused on practice change. At a local level successful implementations engage stakeholders, provide thorough and targeted education, establish interprofesionnal teams, and utilize a phased approach to implementation. Common challenges cited include time, buy-in and lack of resources.
Establishing a national approach to implementing Screening for Distress is both feasible and beneficial. A coordinated approach encourages collaboration beyond the walls of any particular center and provides the opportunity for all patients to be provided with improved person-centered care.
在癌症患者的各个阶段，困扰都是普遍存在的，并被认为是癌症护理的第六个生命体征。尽管困扰普遍存在，并呼吁进行监测，但很少有癌症项目以标准化的方式对困扰进行筛查。本文描述了加拿大采用的实施策略，通过将困扰筛查纳入常规护理来改变实践。
讨论了从困扰概念的提出到实施困扰筛查的过程。突出强调了为将困扰筛查作为一项国家倡议奠定基础的相关开创性工作。此外，还利用了目前正在进行困扰筛查的四个司法管辖区的经验，展示了成功实施的步骤和克服挑战的策略。
将困扰筛查纳入实践需要得到主要利益相关者的认可，制定和传播国家建议和指南，并采用以实践改变为重点的协调和标准化方法。在地方层面，成功的实施需要让利益相关者参与进来，提供全面和有针对性的教育，建立跨专业团队，并采用分阶段的方法进行实施。常见的挑战包括时间、认可和资源缺乏。
建立实施困扰筛查的国家方法是可行且有益的。协调一致的方法鼓励超越任何特定中心的合作，并为所有患者提供更好的以患者为中心的护理提供机会。
