Implementing Distress Management Guidelines in Ambulatory Oncology

Karen Hammelef

Christopher R. Friese

Tara M. Breslin

Michelle Riba

Susan M. Schneider

cancer program development, management, or evaluation, distress, psychosocial aspects, quality improvement
CJON 2014, 18(1), 31-36. DOI: 10.1188/14.CJON.S1.31-36

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.

Jump to a section


    Absolom, K., Holch, P., Pini, S., Hill, K., Liu, A., Sharpe, M., … Velikova, G. (2011). The detection and management of emotional distress in cancer patients: The views of health-care professionals. Psycho-Oncology, 20, 601-608. doi:10.1002/pon.1916
    Carlson, L., Waller, A., & Mitchell, A. (2012). Screening for distress and unmet needs in patients with cancer: Review and recommendations. Journal of Clinical Oncology, 30, 1160-1177. doi:10.1200/JCO.2011.39.5509
    Child, S., McVey, J., & Brooks, A. (2010). A tool to measure psychological distress. Cancer Nursing Practice, 9(6), 33-37. doi:10.7748/cnp2010.
    Eaton, L. H., & Tipton, J. M. (2009). Assessment and measurement. In L. H. Eaton & J. M. Tipton (Eds.), Putting Evidence Into Practice: Improving oncology patient outcomes (pp. 9-22). Pittsburgh, PA: Oncology Nursing Society.
    Fulcher, C. D., & Gosselin-Acomb, T. K. (2007). Distress assessment: Practice change through guideline implementation. Clinical Journal of Oncology Nursing, 11, 817-821. doi:10.1188/07.CJON.817-821
    Graves, K. D., Arnold, S. M., Love, C. K., Kirsh, K. L., Moore, G. P., & Passik, S. D. (2007). Distress screening in a multidisciplinary lung cancer clinic: Prevalence and predictors of clinically significant distress. Lung Cancer, 55, 215-224. doi:10.1016/j.lungcan.2006.10.001
    Greenhalgh, T., Robert, G., Bate, P., Macfarlane, F., & Kyriakidou, O. (2007). Diffusion of innovations in health service organizations. Oxford, England: Blackwell Publishing.
    Hamer, M., Chida, Y., & Molloy, G. J. (2009). Psychological distress and cancer mortality. Journal of Psychosomatic Research, 66, 255-258. doi:10.1016/j.jpsychores.2008.11.002
    Kendall, J., Glaze, K., Oakland, S., Hansen, J., & Parry, C. (2011). What do 1,281 screeners tell us about cancer patients in a community cancer center? Psycho-Oncology, 20, 594-600. doi:10.1002/pon.1907
    Kung-Yee, L., & Zeger, S. (1986). Longitudinal data analysis using generalized linear models. Biometrika, 73, 13-22. doi:10.1093/biomet/73.1.13
    Merckaert, I., Libert, Y., Messin, S., MIlani, M., Slachmuylder, J., & Razavi, D. (2009). Cancer patients' desire for psychological support: Prevalence and implications for screening patients' psychological needs. Psycho-Oncology, 19, 141-149. doi:10.1002/pon.1568
    Mitchell, A. (2010). Short screening tools for cancer-related distress: A review and diagnostic validity meta-analysis. Journal of the National Comprehensive Cancer Network, 8, 487-494.
    Molassiotis, A., Wilson, B., Blair, S., Howe, T., & Cavet, J. (2010). Unmet supportive care needs, psychological well-being, and quality of life in patients living with multiple myeloma and their partners. Psycho-Oncology, 20, 88-97. doi:10.1002/pon.1710
    National Comprehensive Cancer Network. (2012). NCCN Clinical Practice Guidelines in Oncology: Distress management [v.1.2012]. Retrieved from
    Rogers, E. M. (1962). Diffusion of innovations (4th ed.). New York, NY: Free Press.
    Snowden, A., White, C. A., Christie, Z., Murray, E., McGowan, C., & Scott, R. (2011). The clinical utility of the distress thermometer: A review. British Journal of Nursing, 20, 220-227.
    Sollner, W., DeVries, A., Steixner, E., Lukas, P., Sprinzl, G., Rumpold, G., & Maislinger, S. (2001). How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counseling? British Journal of Cancer, 84, 179-185. doi:10.1054/bjoc.2000.1545
    Tuinman, M., Gazendam-Donofria, S., & Hoekstra-Weebers, J. (2008). Screening and referral for psychosocial distress in oncologic practice: Use of distress thermometer. Cancer, 113, 870-878. doi:10.1002/cncr.23622
    Vitek, L., Rosenzweig, M. Q., & Stollings, S. (2007). Distress in patients with cancer: Definition, assessment, and suggested interventions. Clinical Journal of Oncology Nursing, 11, 413-418. doi:10.1188/07.CJON.413-418
    Von Essen, L. V., Larsson, G., Öberg, K., & Sjoden, P. O. (2002). "Satisfaction with care": Associations with health-related quality of life and psychosocial function among Swedish patients with endocrine gastrointestinal tumors. European Journal of Cancer Care, 11, 91-99. doi:10.1046/j.1365-2354.2002.00293.x