• Implementation of a Distress Screening and Management Protocol for Adult Cancer Patients

      Uzupus, Allison M.; Edwards, Lori A. (2021-05)
      Problem: Approximately 50% of cancer patients experience clinically significant cancer-related distress. Unmanaged distress has been linked to decreased medication adherence, increased visits to the emergency room and oncology clinic, increased hospital stays, decreased quality of life and decreased overall survival. At a university-based cancer center in the mid-Atlantic region, informal assessment of patient distress was provider dependent and as a result was inconsistently conducted and documented. Purpose: The purpose of this quality improvement (QI) project was to implement a systematic screening protocol for distress which included a screening tool, staff training, as well as referral processes to identify and manage distress in adult patients with metastatic colorectal cancer. Methods: The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List (DT&PL) was integrated into the patient portal as a questionnaire and sent to patients with metastatic colorectal cancer prior to treatment to be completed prior to their infusion appointment. Infusion nurses reviewed the distress screening with patients during their appointment and made appropriate referrals to clinic-embedded resources such as social work, psychiatry, pain and palliative care, and/or pastoral care based on questionnaire results. Results: The NCCN DT&PL was successfully integrated into the portal as a questionnaire. Overall, 64% of patients completed the questionnaire at least once and 39% of the completed screens indicated high distress. All patients who indicated high distress had documented nursing interventions and/or referrals. Conclusions: Evidence-based distress screening and referral is a feasible practice change to improve patient outcomes. Key facilitators were integration into the electronic health record and personnel to support to initiative.
    • Struggling with paradoxes: The spiritual experience of women with cancer

      Halstead, Marilyn Tuls; Belcher, Anne E. (1998)
      Spirituality is an important aspect of holistic health for women with cancer. Though extensive research focuses on spirituality, three major areas lack delineation. First, the developmental nature of spirituality requires exploration. Second, minimal systematic research directed at understanding spirituality from the perspective of women with cancer is reported. Finally, research exploring spirituality within specific time frames of the cancer trajectory is nonexistent. The purpose of this grounded theory study was to examine the spiritual experience of women diagnosed with cancer within 5 years of initial treatment. Data from two interviews with 10 Caucasian women, ranging from 40-70 years of age, were analyzed using the constant comparison technique. As the women began to suspect a cancer diagnosis, they questioned how this would affect their lives. The diagnosis posed a threat to the meaning they ascribed to their lives. This problem was resolved through the basic social psychological process of Struggling with Paradoxes, a 3-phase process consisting of deciphering the meaning (Phase I), realizing human limitations (Phase II), and learning to live with uncertainty (Phase III). In Phase I, deciphering the meaning, five paradoxes were uncovered that focused on confronting the possibility of their own death, staggering distress, and vulnerability. The women struggled to maintain coherence in old and new ways by connecting in giving and receiving processes. In Phase II, realizing human limitations, the demands of treatment initiated the women's struggle with three paradoxes. Confronting death, connecting for support, and asking the difficult questions were important dimensions that helped the women move toward letting go of ultimate control over their lives. As they entered Phase III, learning to live with uncertainty, the women attained greater well-being but realized that permanent survival could not be assured. In this phase, as the women struggled with two paradoxes, the dimensions of redefining meaning, identifying spiritual growth, reintegration, and facing the possibility of recurrence emerged. Findings confirm the importance of spirituality for women with cancer. Development of curriculum to enhance nurses' knowledge of spirituality is needed. Based on women's perspectives, development and testing of interventions that support and enhance spiritual growth is crucial for research-based practice.