Alberta Cancer Foundation

Check Your Distress at the Door

When health-care providers meet their patients, one of the first things they do is assess patients’ vital signs: body temperature, heart rate, blood pressure respiratory rate and pain level. But there’s a move afoot to measure a sixth vital sign: distress. Dr. Barry Bultz, PhD, is the director of the psychosocial resources and program leader of psychosocial oncology, supportive, pain and palliative care at the Tom Baker Cancer Centre in Calgary and the faculty of medicine at the University of Calgary. He was part of the research team that launched a Personal Well-being Checklist, a new tool that helps health-care providers assess a patient’s distress.

Distress encompasses feelings of discomfort or upset commonly experienced by cancer patients. Distress is rooted in emotional, social, spiritual, practical and physical concerns. Managing a patient’s distress improves quality of life. In a pilot program, willing cancer patients completed the Well-being Checklist devised by Bultz and his team just before meeting with their doctor for the first time at the Tom Baker or Holy Cross centres. Patients answered questions regarding finances, pain, nutrition and more to determine their levels of distress. A copy of the completed checklist also went on file for their doctor to review and address during appointments. The checklist study was the beginning of a national program to assess and address distress in cancer care.

“As a standard of care, we’re trying to get professionals to recognize that the health-care system is much more than just treating the cancer, it’s about treating the patient,” Bultz says. The checklist helped standardize a way to screen patients at cancer centres. It also confirmed that distress should be recognized as the sixth vital sign.

The original version of the checklist asked patients, for example, to rate their level of pain and fatigue in the past week from one to 10. It also asked them to check off daily concerns, such as getting groceries and finding transportation, for example.

Since 2009, Bultz has been using an evolved version of the Personal Well-being Checklist in his clinical practice at the Tom Baker. “I screen patients routinely because it helps me better understand the challenges that they’re facing.” The checklist helps determine what additional resources may help patients cope.

The research is ongoing and it is taking hold in clinics around the world, says Bultz. “We’re always trying to improve clinical care and advance our research.” – M.L.

See to see where the study began. Expect to read more in upcoming issues of Leap about how screening for distress in cancer patients is becoming a standard practice in cancer clinics.