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Psychooncology. 2011 May;20(5):463-9. doi: 10.1002/pon.1932.

Implementing screening for distress, the 6th vital sign: a Canadian strategy for changing practice.

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Department of Psychosocial Resources, Tom Baker Cancer Centre, Holy Cross Site, Alberta Health Services, Cancer Care, Calgary, AB, Canada.



Distress is prevalent among cancer patients at all stages of illness and has been endorsed as the 6th Vital Sign in cancer care. Despite its prevalence, and calls to be monitored, few cancer programs are Screening for Distress in a standardized manner. In this paper, the implementation strategy employed in Canada to change practice by integrating Screening for Distress in routine care is described.


The process from inception of the concept of distress to the implementation of Screening for Distress is discussed. Pioneering work pertinent in laying the foundation for Screening for Distress as a National initiative is highlighted. Additionally, the experience of four jurisdictions currently Screening for Distress is utilized to demonstrate steps to successful implementation and strategies for overcoming challenges.


Integrating Screening for Distress into practice requires endorsements from key stakeholders, developing and disseminating national recommendations and guidelines, and utilizing a coordinated and standardized method focused on practice change. At a local level successful implementations engage stakeholders, provide thorough and targeted education, establish interprofesionnal teams, and utilize a phased approach to implementation. Common challenges cited include time, buy-in and lack of resources.


Establishing a national approach to implementing Screening for Distress is both feasible and beneficial. A coordinated approach encourages collaboration beyond the walls of any particular center and provides the opportunity for all patients to be provided with improved person-centered care.

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