부산대학교 도서관

Psychosocial Dimensions of Care National Comprehensive Cancer Network (NCCN) distress screening guidelines provide basic process recommendations for organizations building distress screening programs (DSP). These guidelines require refinement to ensure the proper fit for the setting. Distress screening is an essential component of patient-centered care, especially in the outpatient setting, where patient volume and visit brevity serve as a barrier to more in-depth patient evaluation, care and support. A nurse-driven DSP was developed and implemented in an outpatient oncology research institution. Unique setting characteristics impacted process development and integration. Nurses used the "Plan, Do, Check, Act" framework to guide quality improvement activities and ensure feasibility and acceptability. Describing lessons learned during the integration of key DSP components from each clinic helped to improve the implementation to subsequent clinics. Nurses initiated a DSP that included screening, assessment, and distress education. If indicated, nurses provided referral consultation and collaborated with interdisciplinary teams. Despite the additional workload, nurses reported benefits from including the DSP tasks in their scope of practice. Lesson: Simplify your DSP to facilitate partner acceptability. From a process integration perspective, each clinic cared for populations with variable acuity and staffing, resulting in the utilization of different DSP components. Problem-solving around these components provided an opportunity for process innovation, particularly from nursing leaders within each clinic. Lesson: Work closely with clinic partners to understand the environment and workflow before implementing a DSP and be willing to adapt the process to meet the needs of the clinic. Identifying the optimal timepoints for screening provided an additional challenge. Based on partner feedback and rapid cycle testing, a simple timepoint like screening at every medical visit was optimal, but the high volume of screening proved unfeasible. Instead, each clinic screened patients at unique timepoints. Lesson: One size doesn't always fit all. To ensure best possible fit, screening timepoints may need to be customized across clinics but should remain simple and generalizable across the population of patients. Successful implementation of a nurse-driven DSP requires a dynamic approach to integration. Feedback based on nursing collaboration with interdisciplinary teams provides problem-solving opportunities to address challenges such as variable clinic workflow, varying patient populations, acuity levels and staffing models. These challenges provided opportunities for innovation, particularly from nursing leaders within each clinic. [ABSTRACT FROM AUTHOR]