NCCN practice guidelines for the management of psychosocial distress. National Comprehensive Cancer Network
Oncology 13(5a): 113-147
1999
ISSN/ISBN: 0890-9091 PMID: 10370925 Document Number: 7188
Guidelines for the management of psychosocial distress are important because every single patient, at every stage of disease, and irrespective of the type of treatment, deals with clinical issues that cause some level of distress. Physicians' communication with patients about these problems is critically important to their total care. The problem has become more acute as more care has shifted to the busy ambulatory care setting, where visits are short and hurried. Surveys conducted in the outpatient clinics at Memorial Sloan-Kettering Cancer Center have found that between 20% to 35% of patients demonstrate a significant level of distress. However, far less than 10% of patients in these clinics actually are referred to a proper resource for psychosocial help. This happens for two reasons: First, the words "psychological," "psychiatric," and "emotional" are as stigmatizing as is the word "cancer." Patients do not want to tell the doctor about such symptoms. Second, the doctor often is too rushed in increasingly brief clinic visits to inquire about psychological concerns. These two barriers keep this area from receiving the kind of attention that it deserves. Yet, it is a critical component of the total care of the person who has cancer. Our panel has addressed the issue of how to improve this aspect of care. We propose the establishment of standards of care for the management of distress, as well as treatment guidelines. At present, there are no standards of care or guidelines for the management of the psychosocial domain of care. Nor is there any oversight or accountability for the recognition and treatment of distress in patients. The Patients' Bill of Rights does not address concerns regarding the psychosocial domain within total health care. Regulatory bodies, such as Jcaho and Hedis, are beginning to address patient decision-making and the ethical aspects of care, but psychosocial care remains one area for which no minimum standards exist. The National Comprehensive Cancer Network (NCCN) Psychosocial Distress Practice Guidelines Panel is composed of representatives from all of the disciplines involved in the delivery of supportive psychosocial services and counseling in the NCCN institutions: social work, nursing, psychiatry, psychology, and clergy. Two oncologists on the panel, as well as a patient advocate, have provided critically important perspectives. We felt that it was important to include chaplains on the panel because of the existential crisis that a diagnosis of cancer provokes, which leads many to seek supportive help from the clergy in dealing with the threat of a life-threatening illness. Traditionally, we have not included clergy in our medical deliberations despite the fact that over 85% of patients state that they draw on their spiritual and religious beliefs when coping with cancer.
Document emailed within 1 workday
