Li Madeline, Macedo Alyssa, Crawford Sean, Bagha Sabira, Leung Yvonne W, Zimmermann Camilla, Fitzgerald Barbara, Wyatt Martha, Stuart-McEwan Terri, Rodin Gary
Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
J Oncol Pract. 2016 May;12(5):e513-26. doi: 10.1200/JOP.2015.010066. Epub 2016 Apr 5.
Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center.
DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement.
There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization.
Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.
在肿瘤诊所对患者痛苦状况进行系统筛查作为改善癌症护理的一种方式已越来越被认可，但其实施面临巨大挑战。我们描述了在一家大型城市综合癌症中心开展和实施痛苦评估与应对工具（DART）项目的情况。
DART是一种电子筛查工具，用于检测身体和情绪痛苦以及实际问题，并与经过分类的跨专业协作护理路径相关联。DART的实施依赖于临床医生教育、技术创新、透明沟通以及基于变革管理和质量改进原则的评估框架。
自2010年以来已完成364,378份DART调查问卷，在过去3年中筛查率持续超过70%。结果显示工作人员满意度高、团队合作意识增强、对患者心理社会需求的临床关注度提高、患者与临床医生之间的沟通以及患者对护理的满意度提高，且未导致转介至专门心理社会服务的情况增加。DART现在是该癌症中心所有就诊患者护理的标准，也是该机构的一项质量绩效指标。
DART实施成功的关键因素包括采用系统性方法、机构的坚定支持以及主要关注基于诊所的应对措施。我们已证明在癌症中心对痛苦状况进行大规模常规筛查是可行的，并且有可能提升患者和工作人员的癌症护理体验。
