December 2015 Vol 6, NO 6

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AONN+ 2015 Highlights

Strategies for Screening and Managing Psychosocial Distress

Carol Gunsch, RN, BScN, CONc, de Souza nurse, Gastrointestinal Diagnostic Assessment Program Nurse Navigator, Grand River Hospital, Waterloo Wellington Regional Cancer Program, Kitchener, Ontario, Canada, and Maureen Watt-Smit, RN, BScN, CONc, de Souza nurse, Education Practice Lead, Oncology Program, part-time faculty, de Souza Institute, Grand River Hospital, Grand River Regional Cancer Centre, shared Cancer Care Ontario’s standardized system for psychosocial distress screening and management at the Sixth Annual Academy of Oncology Nurse & Patient Navigators (AONN+) Conference in Atlanta, GA. “Psychosocial oncology, as per Cancer Care Ontario, focuses on a whole personal approach to cancer care, addressing the social, the psychological, the emotional, the spiritual, and the functional aspects of the patient’s entire journey through an interdisciplinary team, and service providers from various care settings,” Ms Gunsch said.

They shared that, although their interdisciplinary team includes social workers, psychiatrists, occupational therapists, physical therapists, and dietitians who address a wide range of patients’ needs, the nurse navigator is the patient’s first point of contact. “As a nurse, when we’re sitting face-to-face with that client for the first time and they are in distress, we absolutely have the knowledge, the skill, the abilities, and the judgement to incorporate some planning right at that stage,” Ms Gunsch declared.

Distress Screening Tools

They went on to describe how Cancer Care Ontario uses evidence-based research and disease pathways to standardize care in all cancer centers across the province of Ontario, and that Ontario’s cancer survivor rates are among the best in the world. The gold standard distress screening tool in Ontario is the Edmonton Symptom Assessment System (ESAS), which is patient-reported and assesses for the 9 most common symptoms that patients with cancer experience, plus a space to record “other” symptoms. The assessment is completed at each appointment, and captures the symptoms patients are experiencing at that moment in time. “Simply put, it’s a conversation starter,” explained Ms Gunsch. “Besides you walking in the room and explaining your role and asking the patient what they’re here for today, it starts a conversation to assess their baseline measurement.”

The patient-reported functional status (PRFS) is the second distress screening tool used in Cancer Care Ontario. This tool addresses not only how patients are feeling at that moment in time, but also how they were feeling up to 1 month or so previously. “Over the past month, we ask them to rate their activity level. This can, and often does, precipitate whether or not the patients require a dose reduction, or are fit to even carry on,” Ms Gunsch said. The ESAS and the PRFS are completed by patients using a computerized kiosk that takes their insurance information and generates their assessment scores so it is available to the nurse navigator in the clinic before the patient enters. Volunteers are available to help teach patients how to use the kiosks and fill out the ESAS and PRFS.

Symptom Management Guidelines

Cancer Care Ontario also follows a set of evidence-based symptom management guidelines to address psychosocial distress. “We initially use the ESAS score and then go to the symptom that relates to that score through the Cancer Care Ontario website,” Ms Watt-Smit explained. “And there’s actually a tool that will help guide us as to how to respond to that symptom.”

Ms Gunsch and Ms Watt-Smit demonstrated how the ESAS, PRFS, and symptom management guidelines work by acting out a case study of a single mother, aged 48 years, who is newly diagnosed with low-lying colorectal cancer. The patient rated her anxiety a 6 on the ESAS, which is a high level of anxiety. The symptom management guidelines then showed the nurse navigator how to follow up with the patient, which required a secondary assessment and then contacting a social worker. If a social worker is not readily available, nurse navigators can help by using tools such as mood activity charts, a thought record, or muscle relaxation techniques, which are also tools that patients can use outside of the clinic.

Through this case study, the presenters demonstrated how nurse navigators can reduce newly diagnosed patients’ anxiety by helping to normalize their anxieties, providing an opportunity for peer-to-peer support, and reevaluating their anxiety after these discussions. “Sometimes a patient will say their anxiety is 7 out of 10, and there are ways that nurses can help bring that down so they don’t need a social work referral,” Ms Watt-Smit said.

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