Distress management: Clinical practice guidelines in oncology™
Psychosocial care is increasingly being recognized as an integral component of clinical management for patients with cancer. These guidelines recommend that each new patient be rapidly assessed in the office or clinic waiting room for evidence of distress using the DT and Problem List as an initial rough screen (page 454).82 A score of 4 or greater on the DT should trigger further evaluation by the oncologist or nurse and referral to a psychosocial service, if necessary. The choice of psychological service depends on the problem areas specified on the Problem List. Patients with practical and psychosocial problems should be referred to social workers; those with emotional or psychological problems should be referred to mental health professionals, including social workers; and spiritual concerns should be referred to certified chaplains. The primary oncology team members (oncologist, nurse, and social worker) are central to making this model work. Team members look at the score on the DT and the items checked on the Problem List as the first stage of screening. The nurse will follow up with further questions as a second stage of screening. At least one team member must be familiar with the mental health, psychosocial, and chaplaincy services available in the institution and community. A list of the names and phone numbers for these resources should be kept in all oncology clinics and updated frequently. The standards of care should be revised and modified to be compatible with the clinical care offered at each institution. The medical staff and patients should be made aware of the resources available to treat distress and have access to mental health professionals and clergy who are trained to deal with cancer-related distress. The benefits of treating distress in cancer accrue to the patients, their families, and the treating staff, and improve efficiencies in clinic operations. Educating patients and families is equally important to encourage them to recognize that controlling distress is an integral part of cancer care. © Journal of the National Comprehensive Cancer Network.
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