Development, implementation, and initial results of the UC San Diego Health Moores Cancer Center Wellbeing Screening Tool.

OBJECTIVE: All accredited cancer institutions are required to screen patients for psychosocial distress. This paper describes the development, implementation, and preliminary outcomes of the University of California San Diego Health Moores Cancer Center Wellbeing Screening Program. METHOD: Essential steps learned in a formal National Cancer Institute-funded training workshop entitled "Implementing Comprehensive Biopsychosocial Screening" were followed to ensure successful program implementation. These steps included identification of stakeholders; formation of a working committee; establishment of a vision, process, and implementation timeline; creation of a screening tool; development of patient educational material; tool integration into an electronic medical record system; staff training and pilot testing of tool administration; and education about tool results and appropriate follow-up actions. Screening data were collected and analyzed retrospectively for preliminary results and rapid cycle improvement of the wellbeing screening process. RESULTS: Over an 8-month implementation and assessment period, the screening tool was administered 5,610 times of 7,664 expected administrations (73.2%.) to 2,394 unique patients. Visits in which the questionnaire was administered averaged 39.6 ± 14.8 minutes, compared with 40.3 ± 15.2 minutes for visits in which the questionnaire was not administered (t = -1.76, df = 7,662, p = 0.079). SIGNIFICANCE OF RESULTS: This program provides a process and a tool for successful implementation of distress screening in cancer centers, in a meaningful way for patients and providers, while meeting accreditation standards. Further, meaningful data about patient distress and tool performance were able to be collected and utilized.

Evidence-based Palliative Care Approaches to Non-pain Physical Symptom Management in Cancer Patients.

OBJECTIVE: To review effective approaches for non-pain symptom management for cancer patients focusing on treatment of nausea and vomiting, constipation, diarrhea, anorexia/cachexia, fatigue, and dyspnea. DATA SOURCES: Peer-reviewed articles, clinical practice guidelines, professional organization position statements. CONCLUSION: Oncology nurses are key advocates for optimal symptom management. Maximizing palliation of symptoms improves quality of life and prolongs survival. IMPLICATIONS FOR NURSING PRACTICE: To provide an evidence-based approach to symptom management, oncology nurses require a deep understanding of symptom pathophysiology while anticipating side effects, educating patients and caregivers, considering psychosocial/spiritual factors, exploring treatment expectations, and clarifying goals of treatment.