Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned

Accreditation bodies in the USA, the UK, and Europe have mandated that jurisdictions regularly screen patients for distress. While these requirements have been in place for some time, recent reports suggest that facilities still struggle to overcome implementation barriers. In Canada, a Screening for Distress (the sixth vital sign) Initiative was implemented in eight cancer treatment facilities in seven provinces. With national support and coordination from the Canadian Partnership Against Cancer, the initiative’s primary goal was to provide timely and appropriate response to cancer patients’ distress to improve the patient experience. Patient experience is defined as the sum of an individual’s perceptions, expectations and interactions related to his or her health and care throughout the cancer journey (CPAC 2012). The implementation included the application of evidence-informed tools by trained health care professionals to identify distress, facilitate intervention or referral, and enhance collaboration among health care providers to meet patient needs. Implementations have expanded in these facilities since the launch of the initiative and the success of this programmatic approach in Canada may assist other jurisdictions with successful implementation of Screening for Distress (sixth vital sign).

Lesson learned from the Screening for Distress (sixth vital sign) initiative are described in this article to share the experiences of the earlier adopter facilities that may assist other cancer centres wishing to implement a similar program. A description of the intiative and the evaluation approach is included to provide the context for the chief lessons learned about the implementation and sustainability of a Screening for Distress (sixth vital sign) program.

Key lessons about the considerations for effective implementation and sustainability of a Screening for Distress (sixth vital sign) program included the critical significance of an effective change management strategy, leadership, integration, customization, project management, and program evaluation. A number of important knowledge dissemination and exchange strategies were also identified and the importance of overall co-ordination was emphasized.

Cancer treatment centers in Canada have embraced the concept of a formal programmatic protocol for distress screening. The Screening for Distress (sixth vital sign) initiative built on early lessons, expanded to other facilities, and was reported to make a positive contribution to patient care. The distress screening model has a formal place in the cancer system. The lessons revealed through this evaluation are useful to other cancer centers planning a programmatic approach for distress screening.