Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned.

BACKGROUND: Accreditation bodies in the USA, the UK, and Europe have mandated that jurisdictions regularly screen patients for distress. While these requirements have been in place for some time, recent reports suggest that facilities still struggle to overcome implementation barriers. In Canada, a Screening for Distress (the sixth vital sign) Initiative was implemented in eight cancer treatment facilities in seven provinces. With national support and coordination from the Canadian Partnership Against Cancer, the initiative's primary goal was to provide timely and appropriate response to cancer patients' distress to improve the patient experience. Patient experience is defined as the sum of an individual's perceptions, expectations and interactions related to his or her health and care throughout the cancer journey (CPAC 2012). The implementation included the application of evidence-informed tools by trained health care professionals to identify distress, facilitate intervention or referral, and enhance collaboration among health care providers to meet patient needs. Implementations have expanded in these facilities since the launch of the initiative and the success of this programmatic approach in Canada may assist other jurisdictions with successful implementation of Screening for Distress (sixth vital sign). PURPOSE AND METHODS: Lesson learned from the Screening for Distress (sixth vital sign) initiative are described in this article to share the experiences of the earlier adopter facilities that may assist other cancer centres wishing to implement a similar program. A description of the intiative and the evaluation approach is included to provide the context for the chief lessons learned about the implementation and sustainability of a Screening for Distress (sixth vital sign) program. RESULTS: Key lessons about the considerations for effective implementation and sustainability of a Screening for Distress (sixth vital sign) program included the critical significance of an effective change management strategy, leadership, integration, customization, project management, and program evaluation. A number of important knowledge dissemination and exchange strategies were also identified and the importance of overall co-ordination was emphasized. CONCLUSIONS: Cancer treatment centers in Canada have embraced the concept of a formal programmatic protocol for distress screening. The Screening for Distress (sixth vital sign) initiative built on early lessons, expanded to other facilities, and was reported to make a positive contribution to patient care. The distress screening model has a formal place in the cancer system. The lessons revealed through this evaluation are useful to other cancer centers planning a programmatic approach for distress screening.

A Preliminary Investigation of Health and Work-Environment Factors on Presenteeism in the Workplace.

OBJECTIVE: This study investigates the health and work-environment factors that are associated with presenteeism. METHOD: A self-report survey that measured presenteeism, 13 health conditions (eg, stress and allergies), and nine work-environment factors (eg, job strain and leadership) was completed by 229 workers. RESULTS: The most common health condition was stress, while the most common work-environment factor was job strain. Allergies, asthma, and high blood pressure along with work-life imbalance, poor leadership, and a lack of development opportunities were associated with presenteeism. Finally, several inter-relationships between the health and work-environment factors were also reported. CONCLUSION: Interventions targeted at the points of intersection among the health conditions and work-environment factors could be a cost-effective way to improve employees' overall well-being at work, and thus reduce presenteeism.

Impact on Employee Productivity From Presenteeism and Absenteeism: Evidence From a Multinational Firm in Sri Lanka.

OBJECTIVE: This study examines the effects of 13 psychological and physical health conditions on work productivity. METHODS: One hundred fifty-two staff at the headquarters of a Sri Lankan multinational firm completed a questionnaire asking whether they experienced 13 health conditions common in workplaces, and about their related absenteeism and presenteeism. RESULTS: Most respondents (85.5%) reported absenteeism, presenteeism, or both. Among those reporting a health condition, 57.6% reported losing days due to absenteeism, and 69.5% reported losing additional days to presenteeism. Among those caring for a sick adult or child, 57.3% reported losing days due to absenteeism, and 36.5% reported losing additional days due to presenteeism. Overall productivity loss was 10.43 days each year, 3.95% of employee capacity, equating to about Sri Lanka Rupees 8 million (US$54,421) for all headquarters employees. CONCLUSIONS: The health conditions' effects on productivity significantly increased employee costs.

Relationships between work environment factors and presenteeism mediated by employees' health: a preliminary study.

OBJECTIVE: This study investigates a research framework for presenteeism, in particular, whether work environment factors are indirectly related to presenteeism via employees' health. METHODS: A total of 336 employees, 107 from a manufacturing company in Europe and 229 from various locations across North America, completed a self-report survey, which measured the association between presenteeism (dependent variable) and several health and work environment factors (independent variables). These relationships were tested using path analysis with bootstrapping in Mplus. RESULTS: Presenteeism was directly related to health burden (r = 0.77; P = 0.00) and work environment burden (r = 0.34; P = 0.00). The relationship between work environment burden and presenteeism was partially mediated by health burden (ß = 0.08; 95% confidence interval, 0.002 to 0.16). CONCLUSIONS: These findings suggest both a direct and an indirect relationship between work environment factors and presenteeism at work.

Standardized audiotape versus recorded consultation to enhance informed consent to a clinical trial in breast oncology.

BACKGROUND: The purpose of this study was to systematically compare two audiotape formats for the delivery of information relevant to informed consent to participate in a clinical trial in breast oncology, and to establish the feasibility of adding a consultation recording protocol to a clinical treatment trial. METHOD: Participants were 69 women with newly diagnosed breast cancer and 21 oncologists from 5 Canadian cancer centers. Patients were block randomized to one of three groups: 1. standardized audiotape; 2. consultation audiotape; or 3. both audiotapes. Patients received their tapes immediately following the clinical trial consultation. Patient outcomes included perception of being informed about clinical trials, knowledge of information relevant to providing informed consent to a clinical trial, and satisfaction with communication during the consultation. RESULTS: The consultation audiotapes contained less trial-related information than the standardized audiotape but there were no differences in clinical trial knowledge or perception of being informed across the intervention groups. Patients expressed a marginally significant preference for consultation audiotapes over standardized audiotapes. CONCLUSIONS: Patients tended to prefer receiving an audiotape of their own consultation over a standardized audiotape. The majority of oncologists considered the audiotape intervention feasible but were less enthusiastic about being involved in a larger study given the accrual challenges that arose when trying to "piggy-back" one randomized controlled trial on an existing clinical trial.