| Description |
Background: Patients with cancer commonly experience distress and the need for psychosocial care is well recognized as an essential part of cancer care worldwide. However, numerous studies have reported the failure to optimally manage distress. One factor contributing to this failure is underdetection. Identifying psychosocial distress in oncology patients can be difficult without systematic methods. Although the implementation of systematic distress screening among the National Comprehensive Cancer Network (NCCN) member institutions has progressed, oncology patients in inpatient settings continue to be underassessed. Because nurses routinely conduct patient assessments, they are in an ideal position to identify patients in distress and intervene on their behalf.Objective: This scholarly project aimed to improve oncology inpatient nurses' knowledge, attitudes, beliefs, and perceived level of confidence regarding distress screening. Methods: The Distress Education Module was developed and delivered to inpatient oncology nurses at a medical unit of an NCCN member institution, located in Salt Lake City, Utah. The effectiveness of the education module was measured by analyzing changes in nurses' responses in their level of knowledge, attitudes, beliefs, and confidence via the pre- and postsurveys. This DNP project also surveyed participants about their perceived barriers to distress screening. Results: Over 60% (presurvey n=27 and postsurvey n=19) of the eligible nurses participated in the study. Of these, 85.2% (n=23) identified a lack of access to validated screening tools as a moderate to extreme barrier, followed by time constraints (59.2%, n=16). The majority of nurses (74.1%, n=20) did not perceive personal beliefs against distress screening as a barrier. The results from the Mann-Whitney U test demonstrated statistically significant improvements in nurses' knowledge (U=76.000, p=0.000), beliefs (subjective norm) (U=174.000, p=0.033), and confidence levels (U=155.000, p=0.013 and U=190.500, p=0.107). For instance, nurses who reported they were "moderate" to "extremely familiar" with the NCCN's distress guidelines increased by 57.9%. Also, nurses reported an increased frequency in distress screening (U=169.000, p=0.038) and validated tool use (U=173.500, p=0.047) in their practices after the educational intervention: nurses who reported they "often" screen or assess patients for distress improved by 31% and nurses who reported they "never" use validated tools decreased by 32.3%. All nurses who participated in the study responded that they intended to perform routine distress screening. Discussion: This project provided the groundwork for future implementations of distress screening by identifying nurses' barriers and improving their knowledge, beliefs, and confidence levels regarding distress screening and management. Additionally, this project confirmed that the improvement in knowledge, attitudes, beliefs (subjective norm), and confidence levels could develop into actual practice changes. However, this study is limited by a lack of national representation of registered nurses in the US due to the small and homogeneous sample. Further quality improvement projects are recommended to address external barriers at the organizational level, followed by implementation of the formal distress screening and management protocol after barriers are addressed. |
