A systematic, evidence-based approach for screening supportive care needs should be routine and periodic practice. It is recommended that that this occurs at various stages of the cancer journey, including:4, 21
- following diagnosis (e.g. at the initial visit)
- prior to each new phase of treatment (e.g. surgery, chemotherapy, radiotherapy)
- at appropriate intervals during treatment (e.g. significant changes in symptoms, personal circumstances, treatment plan, prognosis)
- at the conclusion of active treatment
- during follow-up
- at recurrence
- during palliative care.
Screening involves the routine and systematic identification of risk factors and potential supportive care needs before the issue becomes problematic.3 Through the process of supportive care screening, health professionals facilitate:3
- Identification and prioritising of needs.
- An immediate response to high-level risk.
- Appropriate follow-up referral(s) and support.
Guided by health professionals with relevant skills, supportive care screening should, where possible, involve a self-assessment process.22 Key steps in screening include:23
- completion of the screening tool by the person affected by cancer or with assistance by a health professional as required
- discussion between the person and the health professional to:
- clarify the identified needs
- evaluate the impact of unmet needs on daily living and quality of life
- plan for further assessment and referral as needed and / or requested by the person
- document the results of the discussion and the completed screening tool.
The tool used to screen supportive care needs should be reliable and valid. Supportive Cancer Care Victoria has collated a number of Screening Implementation Resources.24 These include:
- Supportive Care Screening Tools Summary Guide.
- Points to consider when selecting a screening tool.
A validated and widely used tool, developed by the National Comprehensive Cancer Network, is the Distress Thermometer and Problem List (Figure 5).21
The level of distress experienced is identified on a 0-10 scale and the problem list enables identification of issues in the past week related to practical, family, emotional or physical problems and spiritual/religious concerns. The score identified on the distress thermometer may guide clinical decision making. All identified problems should lead to a discussion to explore the individuals’ concern/s. If there are a large number of problems identified the health professional could ask the person to prioritise concerns. A score ≥4 may indicate significant distress and warrants discussion. Focused assessment and referral to specialised care may also be required.21
The Distress Thermometer and Problem List may be used by any member of the multidisciplinary team within their scope of practice and level of competence.25 Use of the checklist to facilitate discussion of problems has been associated with enhanced communication and rapport as it encourages patients and clinicians to discuss concerns which they may have otherwise been hesitant to do.26
Figure 5: NCCN Distress Thermometer for Patients27
The consumer resource, Cancer – how are you travelling?28, contains several copies of the Distress Thermometer that individuals may use independently or prior to a follow-up appointment.
NCCN Distress Thermometer for Patients (PDF, 296KB). National Comprehensive Cancer Network, 2013.27
Targeted supportive care needs assessment tools have been developed for some specific populations.
- Garvey, G., et al. (2012). The development of a supportive care needs assessment tool for Indigenous people with cancer. BMC Cancer, 12: 300
- Waller, A., et al. (2010). Validity, reliability and clinical feasibility of a Needs Assessment Tool for people with progressive cancer. Psychooncology, 19(7): 726-733.
- Girgis, A., et al. (2011). The next generation of the supportive care needs survey: a brief screening tool for administration in the clinical oncology setting. Psychooncology, 21(8): 827-835.
- Breen, S., Ristevski, E., & Regan, M. (2012). Enabling supportive care screening and evidence-based referrals for patients with cancer: Patient acceptability and clinician implementation of the supportive care resource kit (SCRK). The Australian Journal of Cancer Nursing, 13(1): 20-31.
Watch the vignette Jane’s Story 3, to meet Jane. Follow her journey as she presents for her first treatment in the case study below:
It is a busy morning in the day therapy unit. Jane is presenting for her first cycle of chemotherapy for ovarian cancer post-surgery. You notice her in the waiting area… tapping her feet, nervously holding a child’s soft toy in her hands. You approach Jane in the waiting area.
“ Hi Mrs Cooper, My name is Sara. I will be one of the nurses caring for you today. I see from your patient record that today is your first day of treatment.”
“Oh, yes, yes it is. To tell you the truth I’m feeling a little nervous. I don’t know what to expect with this treatment. I‘m thinking about my boys. The little one, so sweet, he gave me his favourite toy to keep Mummy company at the hospital today.”
“That is very sweet. Well, I can give you information about the treatment you are going to have and what to expect along the way. While we wait for a quiet room to be available for us to speak further, would you mind filling in this questionnaire which asks about you and your health, and how you might be feeling and any concerns you may have. It will help us provide the best support and care for you. It will only take about five minutes and most of the questions are tick boxes. There is also room on the form to add anything else of concern. Is that ok for you to fill it in?”
“Sure, what will you do with it after I complete it?”
“Once you have completed it, we can sit together and talk about your concerns and determine the best ways to support you during treatment.
“Okay, there are a few things on my mind, so this might be useful to me.”
You review Jane’s patient file. She is 36 years old and has had a total abdominal hysterectomy and bilateral salpingo-oopherectomy 16 days ago. She has been diagnosed with Stage III ovarian cancer. She is married with a young family.
After five minutes you go to collect the questionnaire.
“Thanks for completing the form. I have organised a comfortable room for us to discuss your responses.”
Review the Distress Thermometer and Problem List completed by Jane.
- What level of distress has Jane indicated on the Distress Thermometer?
- What is the significance of this level of distress?
- Based on the Problem List, what issues will be the focus of your discussion with Jane?