RCN Distress Screening (''PROM:ISE'') (Dr. Adrian Langleben, Fabienne Germeil)

Note: The program previously known as “Refocus” has been renamed 'PROM:ISE' - (Patient Reported Outcome Measures for Interdisciplinary Symptom Evaluation)

Distress is a common concern across the cancer trajectory, beginning at diagnosis and extending to the post-treatment phase of cancer and longer term. All patients experience distress in response to a cancer diagnosis and treatment effects, and prevalence rates for significant levels of distress in patients with cancer range from 22% to 58%. Heightened distress is associated with worse patient outcomes, in terms of worse health-related quality of life, lesser treatment adherence, lower satisfaction with care, and possibly lower survival.

Over the last decade, Patient Reported Outcomes (PROs) have been used for distress and symptom screening in an oncology setting. Evidence shows that the use of PROs prompts discussion of patients’ concerns and increases symptom awareness as well as understanding of the patient experience. This in turn leads to better symptom management, quality of life, and increased survival.

The RCN Distress Screening project aims to expand the use of PROs in the clinic setting and to mobilize healthcare teams to respond to concerns more proactively, as opposed to reactive assessment.

  • At the MUHC, PROs have been collected and discussed in the Psychosocial Oncology (PSO) and Pain clinics, Palliative and Supportive Care Day hospital, Lachine supportive care clinic, and in Radiation Oncology for Glioblastoma patients. The next step is to integrate Lung cancer patients.
  • At the SMHC, PROs collection has been expanded to all active treatment patients (IV chemotherapy and oral medications), via the treatment area and medical oncology clinics.
  • At the JGH, PROs collection is currently being piloted in the IV chemotherapy clinic, and will soon be rolled out to Lung cancer patients.

In 2021, the RCN focused the Distress Screening project in the form of a prospective clinical trial involving newly diagnosed lung cancer patients across the network. In so doing, we have begun collecting a common set of core symptoms and statistics for the same patient population.

The RCN is proud to support this initiative by implementing systematic distress screening for all patients within the project scope and ensuring appropriate response by healthcare professionals. As part of the RCN’s commitment to this program and to embedding resources within RCN hospitals, we have staffed this project with three full-time Distress Screening Coordinators. Each RCN site now has a dedicated resource person to manage the day-to-day activities of distress screening, and to ensure a cohesive and sustainable approach to implementation. Finally, regular reporting of patient severity scores through monthly dashboards, and reporting of interventions recommended by clinicians will promote continuous improvement.


 RCN Retreat video of Dr. Langleben & Beverly-Tracey John's presentation Distress Screening: An RCN Clinical Trial 


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