Purpose: The Department of Surgery at the New Mexico VA Health Care System (NMVAHCS) is striving to improve the delivery of reliable, quality cancer services. Recognizing the impact of a cancer diagnosis and the accompanying psychosocial distress, the department is dedicated to the provision of personalized, proactive, veteran-centered cancer care. The DISTRESS (Distress Initial Survivorship Tool Recommended Evaluation through Surgical Service) system complies with the 2015 phase of the Commission on Cancer (COC) standards addressing physical, psychological, social, financial, and spiritual issues, which complicate treatment plans and negatively affect outcomes (www.facs.org).
Methods: A multidisciplinary group of content experts explored the current state of cancer-related psychosocial distress and developed a standardized process to improve assessment and access to cancer related distress care. The DISTRESS system was developed and incorporated into the CPRS Cancer Survivorship Care Plan, creating permanent data within the medical record. Veterans surgically diagnosed with cancer complete the DISTRESS screening tool and discuss responses with their provider during the postsurgical visit, “a pivotal medical visit,” as required by the COC. Veterans acknowledging distress and willing to seek assistance are automatically referred to the appropriate psychosocial service. The DISTRESS system design incorporates specific distress monitoring fields, triggering the generation of appropriate consultations through CPRS to Palliative Care, Behavioral Health Care, Social Work, and/or Chaplin services, with the veterans acceptance of care.
Results: This automated and systematic process within CPRS provides veterans with consistent psychosocial care and enables self-awareness. Veterans empowered with resources experience improved mental health and social well-being through the identification of positive coping skills, promoting an optimal survivorship experience. Patients lacking the ability to engage in care often become despondent or noncompliant, reducing the opportunity for positive outcomes. The integration of monitoring fields within the care plan creates the ability to track compliance; identifying patients otherwise lost in the transition of care. Embedding the DISTRESS system in the Cancer Survivorship Care Plan allows all care providers access to information for assessment of referral outcomes and the continuity of care. It also serves as a mechanism to track and report psychosocial distress and referrals to the Cancer Committee as required in the phase-in 2015 COC guidelines. Since implementation of the Cancer Survivorship Care Plan, 100% of veterans diagnosed with colon cancer received psychosocial distress assessments and appropriate referrals. Physician feedback has been very supportive, because the exchange of clear and concise data has improved communication between the multidisciplinary care team and improved veteran access to services.
Conclusions: The DISTRESS system provides a consistent psychosocial assessment incorporated into the CPRS Cancer Survivorship Care Plan, upholding guidelines by providing mandatory reporting fields for the provider to assess and address. It offers a systematic, standardized, and sustainable process for psychosocial assessment of veterans diagnosed with cancer. Health factors built into the system provide a way of tracking missed appointments and outcomes of care. The Surgical Services Department at the NMVAHCS strongly believes in veteran-centered care through using the DISTRESS system and engaging veteran participation in its plan of care.
