Implementing a screening programme for distress in cancer settings: Science and practice

Abstract

Objective. Previous work has addressed the development and diagnostic validity testing of tools for measuring cancer-related distress. Relatively little has been published on the implementation of these tools in clinical practice. We aimed to review the findings of randomized and non-randomized trials of the effect of distress screening to identify the effectiveness and acceptability of screening programmes. Methods. A search was made of the Embase/ Medline and Web of knowledge abstract databases from inception to May 2012. Our inclusion criterion was randomized and non- randomized controlled trials concerning the effect of screening for psychological distress on patient and clinician reported outcomes. We included studies on quality of life. Results. We identified 21 qualifying studies. Twelve were randomized trials and nine were non-randomized trials of the effect of screening for psychological distress. Six randomized trials assigned patients to receive screening or no screening, the remainder randomized patients to receive feedback or no feedback of screening results. Only 6 of the randomized reported benefits (five as a direct result of screening), although an additional 8 non-randomized studies showed partial benefits. Most benefits were seen in domains of communication, clinician behaviour and patient referral. Acceptability of screening was high during funded screening implementation studies but mixed when incorporated into routine clinical care. Conclusions. Screening for distress has the potential to influence communication, clinician behaviour and patient referral and to a lesser extent recognition of distress and unmet needs. Barriers to implementation success include low staff confidence, lack of training and support, low acceptability and failure to tie treatment to the screening results. Further work needs to be conducted on the value of screening when incorporated into routine clinical care and into the most appropriate methods for studying the implementation of screening in clinical practice.