Screening for Supportive Oncology Patient Concerns, Analyzing Impact and Opportunities to Improve Spiritual Questions Affecting Navigation to Spiritual Resources

November 2017 Vol 8, No 11
Stephanie Merce Boecher, RN, OCN, MSN, BSN, BA
Julia R. Trosman, PhD, MBA

Background: The Institute of Medicine (IOM) 2013 report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from the NCCN Distress Problem List, IOM report, and CoC standards, with validated subtools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue, and physical function.1,2 Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public, and 1 safety net). Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, nutritional and specific treatment/care concerns, and lower physical function (P <.0001).3 Participating sites voiced concerns about the 3 spiritual questions on the screening tool because they were worded to be triggered by a “No” response rather than a “Yes” response.

Objective: Assess spiritual questions on the Coleman Supportive Oncology Screening Tool and identify opportunities to improve the spiritual screening questions and navigation to spiritual resources.

Methods: The Coleman Supportive Oncology Collaborative (CSOC) analyzed patient answers to 3 spiritual questions in the CSOC screening tool at 2 cancer treatment sites (1 public and 1 academic). Descriptive statistics were used. CSOC nurses/navigators conducted discussions with chaplains to identify improved screening options as supported by recent literature.

Results: The CSOC screening tool was completed by 512 patients. The question “I have a sense of purpose or meaning” received an answer of “No” by 22.7% (116/512) of patients; the question “I feel peaceful” received an answer of “No” by 19.1% (98/512) of patients; and the question “I find strength in my faith and beliefs” received an answer of “No” by 11.5% (59/512) of patients. Additional analysis identified that 73% (72/98) of patients who answered “No” to the “I feel peaceful” question also answered “No” to 1 or 2 of the other spiritual questions. Of the remaining 26 patients, 16 patients had a PHQ-4 score of 3 or higher that triggered a navigation to psychosocial support; 8 patients with a PHQ-4 score lower than 3 stated “Yes” to practical/family concerns that triggered navigation to psychosocial support. The remaining 4 patients (<1% of 512), all had other concerns indicated on their screening tool (nutrition, treatment/care, or physical concerns) that triggered further staff navigation. CSOC chaplains encouraged rewriting screening questions to align with the paper by King et al,4 “Determining Best Methods to Screen for Religious/Spiritual Distress.” The suggestion was to remove the “I feel peaceful” question and reword the other 2 questions to be triggered by “Yes” responses.

Conclusions: Based on data analysis and spiritual literature, the CSOC navigators, chaplains, nurses, social workers, palliative care physicians, and psychologists adjusted the screening tool. The 3 spiritual questions were replaced with “Do you struggle with the loss of meaning and joy in your life?” and “Do you have religious or spiritual struggles?” that trigger navigation with a “Yes” response. Revised questions are under pilot testing at 3 cancer centers.


  1. Weldon C, Vance N, Scheu A, et al. A consolidated screening tool for supportive oncology needs and distress. J Clin Oncol. 2017;35(suppl). Abstract 47.
  2. Weldon CB, Vance N, Scheu A, et al. Pilot results of consolidated screening tool for distress and supportive oncology needs, AB2017-03. J Natl Compr Canc Netw. 2017;15:658.
  3. Trosman JR, Gerhart J, Patel U, et al. Results of implementing a novel supportive oncology screening tool for comprehensive evaluation of distress and other supportive care needs. J Clin Oncol. 2017;35(suppl). Abstract e21644.
  4. King SD, Fitchett G, Murphy PE, et al. Determining best methods to screen for religious/spiritual distress. Supp Care Cancer. 2017;25:471-479.
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