Expanding the NCCN guidelines for distress management: a model of barriers to the use of coping resources.

Cancer-related distress impacts quality of care, resource use, and patient outcomes. Patients are increasingly screened for distress, yet many do not receive coping resources and psychosocial support services that may help to reduce their distress. Distress screening must be paired with attention to the different phases of the distress and coping process, with emphasis on barriers and facilitators of cancer patients' use of coping resources. This paper offers a conceptual model illustrating key pathways and modifying factors of distress and use of coping resources among cancer patients, and potential roles for cancer care providers and institutions in facilitating effective coping and distress reduction. Building on a review of relevant empirical and theoretical literature, we developed a conceptual model that integrates concepts from Stress and Coping Theory into the National Comprehensive Cancer Network's guidelines for Distress Management. We found that barriers and facilitating factors that may inhibit receipt of coping resources and services to reduce cancer-related distress include health and cancer beliefs, accessibility and acceptability, the role of caregivers in cancer treatment, coordination of care, and the quality of patient-provider relationships. Herein, we highlight largely modifable factors that can infuence the successful uptake of coping resources and services to reduce distress among cancer patients. We conclude with recommendations for how cancer care providers and systems can better identify and address barriers to the use of distress reduction resources and support services.

Implementing distress management guidelines in ambulatory oncology: a quality improvement project.

Distress assessment and referral to psychosocial services is an essential component of evidence-based oncologic nursing care. Oncology nurses have an opportunity to address patient distress needs through leadership of implementation programs and support for the positive outcomes that engaging in psychosocial services provides. This quality improvement project was conducted to evaluate the feasibility and utility of the National Comprehensive Cancer Network's distress management clinical practice guidelines in ambulatory oncology. A theoretical framework guided the process design that included staff education, screening, and management in a cohort implementation project with historical control.

Improving a grief and loss program: caring for patients, families, and staff.

The University of Michigan Comprehensive Cancer Center (UMCCC) Grief and Loss Program provides supportive care services during bereavement which is considered part of the care continuum. This program received 50 death notifications per month upon project initiation and currently receives approximately 125 per month. Initial program evaluation was conducted via a pilot survey of bereaved parents as well as verbal and written evaluations from the transdisciplinary staff of Patient and Family Support Services. Grief support prior to evaluation included mailings, phone calls as indicated, poorly attended bereavement support groups, and limited staff support. Based on program evaluation, grief support continues through the use of mail/e-mail and phone calls to those at risk for complicated grief Three to four gatherings per year are offered rather than monthly support groups, and connections to community resources are provided. The Comfort And Resources at End of Life (C-A-R-E) program was implemented to support and educate staff. Next steps include further program evaluation and potential research to examine best practices for the bereaved.

Fertility considerations, counseling, and semen cryopreservation for males prior to the initiation of cancer therapy.

An innovative program jointly sponsored by members of the departments of obstetrics and urology and the Comprehensive Cancer Center at the University of Michigan began in 2002. The Fertility Counseling and Gamete Cryopreservation Program (FCGCP) was created to provide counseling and education about therapy-induced infertility to newly diagnosed patients with cancer as well as facilitating the semen cryopreservation process. Unlike most sperm banking facilities in this country, this program is coordinated by an oncology nurse practitioner whose understanding of cancer and cancer treatments provides patients and staff with a unique perspective. Oncology staff misconceptions about sperm banking were addressed through intensive staff education programs. Patient education materials covering all aspects of infertility and sperm banking were developed and made available in patient care areas and on the Internet. Material aimed at young adolescents and their parents is prominent. Developmentally appropriate discussions are held with adolescent patients and their parents, both individually and together. Communication among patients and their families, the oncology team, and the sperm bank is maintained, permitting efficient and timely service. FCGCP provides an important service by affording all males with cancer the potential to father a child in the future.