Agarwal Priyal, Patel Pranav M, Powell Caleb, Kesireddy Meghana
Division of Hematology and Oncology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
University of Toledo College of Pharmacy and Pharmaceutical Sciences, Toledo, OH, USA.
J Cancer Surviv. 2025 Apr 16. doi: 10.1007/s11764-025-01807-3.
This systematic review aims to examine the workflows in distress screening and referral using the NCCN distress thermometer (DT) in the US, aiming to identify key elements for flexible, organization-specific approaches.
A systematic review of full-text manuscripts published from 2013 to May 2024 was conducted using MEDLINE, EMBASE, and CINAHL. Studies describing distress screening and referral protocols were included, while systematic reviews, commentaries, non-US studies, non-English publications, and studies on distress score-disease burden associations were excluded. Attributes of distress screening and referral pathways were extracted.
From an initial 1219 articles, 19 studies were included. Significant variability was observed in NCCN DT workflows, particularly in responder characteristics (e.g., cancer type, patient vs. caregiver). Nursing staff primarily administered screenings, varying by mode (paper vs. electronic), frequency, and location (home vs. clinic). A cut-off score of 4 or higher often triggered referrals, with some studies further stratifying distress levels for tailored follow-ups. Referral pathways included educational resources, behavioral and emotional health, social support, and rehabilitative and supportive care services. Caregiver distress screening was infrequent.
This review underscores the variability in NCCN DT workflows and the need for customizable protocols. While standardization is desirable, some variation is essential to accommodate the differing availability of resources and personnel for effective distress screening and referral.
Effective distress screening and referral pathways ensure survivors receive timely psychological, emotional, and social support, improving quality of life. Integrating caregiver distress screening into workflows could amplify overall support systems, fostering holistic survivorship care. A flexible yet structured approach enhances access to tailored interventions, promoting resilience in survivors and caregivers.
本系统评价旨在研究美国使用美国国立综合癌症网络（NCCN）苦恼温度计（DT）进行苦恼筛查和转诊的工作流程，旨在确定灵活的、针对机构的方法的关键要素。
使用MEDLINE、EMBASE和CINAHL对2013年至2024年5月发表的全文手稿进行系统评价。纳入描述苦恼筛查和转诊方案的研究，排除系统评价、评论、非美国研究、非英文出版物以及关于苦恼评分与疾病负担关联的研究。提取苦恼筛查和转诊途径的属性。
从最初的1219篇文章中，纳入了19项研究。观察到NCCN DT工作流程存在显著差异，尤其是在应答者特征方面（例如癌症类型、患者与护理者）。护理人员主要进行筛查，筛查方式（纸质与电子）、频率和地点（家庭与诊所）各不相同。4分或更高的临界值通常会触发转诊，一些研究进一步对苦恼程度进行分层以便进行针对性随访。转诊途径包括教育资源、行为和心理健康、社会支持以及康复和支持性护理服务。护理者苦恼筛查很少见。
本评价强调了NCCN DT工作流程中的差异以及对可定制方案的需求。虽然标准化是可取的，但一些差异对于适应不同的资源和人员可用性以进行有效的苦恼筛查和转诊至关重要。
有效的苦恼筛查和转诊途径可确保幸存者获得及时的心理、情感和社会支持，并改善生活质量。将护理者苦恼筛查纳入工作流程可增强整体支持系统，促进全面的生存护理。灵活但结构化的方法可增加获得针对性干预措施的机会，增强幸存者和护理者的复原力。
