e-35 oe VOL. 11, NO. 3, AUGUST 2012 FEATURE Ensuring a high-quality response to Screening for Distress data Systematic knowledge translation is needed to improve patient experience by Doris Howell, RN, PhD; Barry Bultz, PhD, CPsych; Margaret Fitch RN, PhD; Shannon Groff, BSc; Andrea Williams, BA; Laura Cleghorn, MA Doris Howell RN, PhD is RBC Chair, Oncology Nursing Research and Education at Princess Margaret Hospital in Toronto, ON and Lead, Guidelines and Standards, Cancer Journey Portfolio, Canadian Partnership Against Cancer (CPAC); Barry Bultz, PhD, CPsych is Director of the Department of Psychosocial Resources at the Tom Baker Cancer Centre, University of Calgary and Lead, Screening for Distress, Cancer Journey Portfolio, CPAC; Margaret Fitch RN, PhD is Head of Oncology Nursing and Co-Director of the Patient and Family Support Program, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto; Shannon Groff, BSc is Coordinator, Screening for Distress, Cancer Journey Portfolio, CPAC; Andrea Williams, BA is Project Assistant, Screening for Distress, Cancer Journey Portfolio, CPAC. Laura Cleghorn, MA, is a consultant with Cardinal Consultants in Toronto. ABSTRACT A cross Canada, efforts are underway to implement Screening for Distress as the 6 th Vital Sign as part of routine cancer care. Significant progress has been made in recognizing the need for a programmatic approach to the implementation of Screening for Distress. Additionally, there is acknowledgement of the importance of preparing front-line clinicians in the active management of distress, and pan-Canadian guidelines and algorithms have been developed to support this effort. However, there is an urgent need to understand the case for knowl- edge translation to be integrated as an essential element of a programmatic approach to Screening for Distress, to ensure a high-quality response to distress data based on the evidence in these guidelines. In this paper, we describe some of the essential steps in translating guideline evidence into action based on the Knowledge-to-Action framework, as well as key learning from a pan-Canadian knowledge translation workshop. A programmatic approach requires that healthcare organizations focus equal attention on knowledge translation to ensure a high-quality front-line clinical response to Screening for Distress data, if improve- ment of the patient experience of cancer and health out- comes is to be realized. Key words: distress, 6th Vital Sign, screening, knowl- edge translation, implementation, best practices INTRODUCTION Routine Screening for Distress as the 6 th Vital Sign 1 is now standard of care for Canadian cancer organizations, 2 to ensure recognition of the psychosocial, practical and physical conse- quences of cancer and treatment that contribute to distress, as well as early identification of those patients in need of more intensive interventions. 3 The Cancer Journey Portfolio of the Canadian Partnership Against Cancer (CPAC) has been supporting 9 jurisdictions across Canada to implement a programmatic approach to Screening for Distress as the 6 th Vital Sign to enhance person-centred care and ultimately improve health-related quality of life. 4 It is recommended that a programmatic approach encompass care processes, inclu- sive of therapeutic communication to ascertain the person’s perspective of the problem, and a focused assessment to guide the selection of relevant and appropriate evidence-based interventions to ensure an effective response to Screening for Distress data (Figure 1). Naturally, a programmatic approach would also include education for patients about the need for screening and engagement of organizational leaders and clinical teams to recognize the imperative for routine screening. Without this approach, there is little high-quality evidence to suggest that routine collection of patient-reported screening data will improve health outcomes, 5-8 with the exception of patients with depressive symptoms referred for specialist intervention. 9 Even though clinicians value screening data in overall patient assessment, the way these data are used in routine clinical practice and the effectiveness of the response to screening data is critical if health outcomes are to be realized. 10 The purpose of this paper is to highlight the case for knowledge translation as an essential element of a pro- grammatic approach to Screening for Distress as the 6 th Vital Sign, and the steps that are necessary if such an approach is to improve patient outcomes and experience of cancer. LINKING CLINICAL PRACTICE TO SCREENING FOR DISTRESS DATA In order to ensure a high-quality response to Screening for Distress data, clinical practice guidelines and algorithms with care pathways were developed under the auspices of the © 2012 Parkhurst, publisher of Oncology xchange. All rights reserved.