A Role for Cancer Nurses: Responding to Distress in Cancer Patients


  • Margaret Fitch Sunnybrook Health Sciences Centre, Toronto
  • Deborah McLeod QEII Health Sciences Centre, Halifax
  • Doris Howell University Health Network, Toronto
  • Esther Green Cancer Care Ontario, Toronto




cancer nurses, person-centered care for cancer patients


Background: Although all patients experience distress, between 35-45% experience clinically significant levels of distress such as anxiety, depression and adjustment difficulties. Early identification of distress and the provision of relevant interventions is a standard of quality cancer care. Nurses have a critically important role in identifying individuals with distress and providing interventions to manage distress.

Objectives: Our objectives are to define the role of cancer nurses in responding to emotional distress experienced by cancer patients and to document the best practices for implementing a program of screening for distress in ambulatory settings.

Methods: A programmatic approach to screening for distress (6th vital sign) has been implemented in several cancer facilities across Canada. The program includes protocols for screening, algorithms for assessment, and guidelines for evidenced based interventions. Introduction of the programs have included relevant education of nurses and close attention to uptake and utilization of practice guidelines. Implementation has been mounted within the context of continuous quality improvement and the use of rapid cycle evaluation.

Results: Evaluation of successful program implementation has shown increased patient satisfaction with care. Patient concerns provide the focus for opening conversations with individuals and the basis for planning person-centered approaches to care. Patient concerns are identified through the screening maneuver beyond those related to tumor and side effect management. Nurses are in an excellent position to respond to scores on a standardized distress screening tool as part of their patient assessments. The assessments provide a foundation for individualized or tailored interventions.

Conclusions: Using a concrete programmatic approach, including screening, focused evidence-based assessment and interventions, offers benefits in achieving person-centered care for cancer patients. In busy clinical settings, an intentional effort is needed to implement a programmatic approach to screening followed by appropriate assessment and intervention.

Author Biographies

Margaret Fitch, Sunnybrook Health Sciences Centre, Toronto

Deborah McLeod, QEII Health Sciences Centre, Halifax

Doris Howell, University Health Network, Toronto

Esther Green, Cancer Care Ontario, Toronto



How to Cite

Fitch, M., McLeod, D., Howell, D., & Green, E. (2014). A Role for Cancer Nurses: Responding to Distress in Cancer Patients. The International Journal of Whole Person Care, 1(1). https://doi.org/10.26443/ijwpc.v1i1.62