Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies

Abstract

Purpose of review Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services. Recent findings Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies. Summary Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.

A qualitative study investigating Australian cancer service outpatients’ experience of distress screening and management: what is the personal relevance, acceptability and improvement opportunities from patient perspectives?

“…Clinical guidelines recommend that everyone responsible for the patient care should be at least aware of how the patient is progressing through the distress screening and management pathway [ 13 ]. However, an implementation barrier often cited is confusion as to roles and responsibilities in this process and the lack of time and confidence to ask about distress and provide follow-up [ 18 , 20 ]. Developing specific roles and responsibilities for the members of the multidisciplinary team along with training modules would facilitate distress screening implementation models.…”

“…Firstly, there remains debate on the utility of single-item distress screening tools, such as the distress thermometer (DT) [ 16 ], especially without the use or availability of a well-structured referral pathway [ 16 , 17 ]. Secondly, the implementation of distress screening programs is poorly reported, and it is likely that only select components of evidence-based approaches are being incorporated in health services, such as one-step screening or no rescreening [ 18 , 19 ]. These two factors may have contributed to emerging reports that health professionals and services are unclear on the potential benefits of distress screening programs and thus unable to rationalize both the real and opportunity cost of yet another clinical activity [ 20 ].…”

Screening for distress in cancer care: How to overcome barriers after unsuccessful implementation?

“…Patients with cancer also deserve adequate mental health care that meets the highest standards of care. Despite the growing data on effective strategies and implantation facilitators, there remains little data on what are the key measures essential for the implementation strategy and what are the best predictors of program implementation success (McCarter et al, 2018(McCarter et al, , 2020. All these questions remain unanswered and should warrant more research.…”

“…Interestingly, 95% of the implementation goals were successfully completed by cancer centers that have adhered to the training programs, after just 2 years of participation (Knies et al, 2019). To guide institutions in choosing effective models and locally contextualize principles, some experts recommended in fact further studies that evaluate minimum components (McCarter et al, 2020).…”

Stress-Related Growth Scale-Short Form: A Portuguese validation for cancer patients

“…Human beings are often faced with challenges that can inflict different degrees of instability, suffering, uncertainty and incomprehension. For triggering a cascade of physical, psychosocial, practical and existential demands ( Denlinger et al, 2020 ; McCarter et al, 2020 ; Riba et al, 2019 ), the diagnosis of a cancer and the anticancer multimodal treatments, can constitute one of these disruptive stressful life events, sometimes even traumatic ( Cordova et al, 2017 ; Kaster et al, 2019 ; Marziliano et al, 2020 ; Ochoa et al, 2017 ). Therefore, cancer diagnosis and treatment are associated with increased risk for emotional distress and mental comorbidity ( Alarcón et al, 2020 ; Gil-Moncayo et al, 2020 ; Götz et al, 2019 ; Kuba et al, 2019 ; Mehnert et al, 2018 ; Zebrack et al, 2017 ).…”