Implementing the NCCN® 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 care. This cohort quality improvement project with historical control was conducted at the hematology and oncology offices and treatment area in a satellite clinic of an NCI...-designated comprehensive cancer center. The project aims were to evaluate the feasibility and utility of the National Comprehensive Cancer Network's (NCCN...) distress management clinical practice guidelines in ambulatory oncology. 175 adults with cancer were administered the NCCN... distress screening tool at patient appointments over 4 weeks. A survey was distributed to the 38 staff participating in their care at project conclusion. The Diffusion of InnovationsModel provided the theoretical framework for the process design. The project components included staff education, screening and algorithm- based referrals to psychosocial services via a psychosocial intake center. A historical control group of patients from the same setting were examined for rate of referral to, and receipt of psychosocial services. A distress screening rate of 61.5% was calculated in the implementation group with a mean distress level of 2.81 and a 26.2% rate of referral. Notably, the rate of service delivery in the population with distress scores of four or greater was found to be 58.9%. Odds of receiving a referral were 5.84 times greater for patients in the implementation group than for the control group. 31.4% indicated moderate distress (level 4-7) and 6.5% high distress (level 8-10). 29 (76%) of the staff completed the survey: 100% found the process clinically relevant, 68% were satisfied with the process, 88% described the tool as easy or very easy to use, 80% noted their workload stayed the same and 86% recommended the continued use of the process. With modification, the NCCN... distress management guidelines can be successfully implemented in ambulatory oncology. Suggested modifications to the screening tool include selection options for desire for referral to, and satisfaction with, current psychosocial service. Identified barriers and facilitators of the process provide guidance for future implementation of distress screening and management including the potential confounding effect of pain assessment scales on reported distress levels. Identified barriers and facilitators of the distress management process provide guidance for future implementation projects and distress management proc