CANO/ACIO Supports Distress as the 6th Vital Sign

Unmanaged emotional distress in people (children and adults) dealing with cancer and their families is of concern to oncology nurses. Oncology nurses see, first hand, the impact that distress has on the person and family throughout the cancer journey. Distress permeates all aspects of life and is prevalent throughout all phases of the cancer experience. It effects decision-making and influences one's ability to perform activities of daily living. Oncology nurses see distress in the faces of patients and families and they hear the stress in their voices when faced with an initial diagnosis of cancer or recurrence. Oncology nurses, like other members of the Health Care Team see distress in patients and families and spend considerable time assisting them to cope with distress.

CANO/ACIO's Position
CANO/ACIO supports distress as the 6th vital sign. Canadians dealing with cancer and their families experience emotional distress due to the illness, the impact of the treatment, survivorship and rehabilitation issues, and death and bereavement.

What You as a CANO/ACIO Member Can Do
CANO/ACIO nurses can show support of distress as the 6th vital sign through activities such as:

  • Consistently assessing distress with an evidence-based approach. There are a number of valid and reliable tools to assess distress including the National Comprehensive Cancer Network's distress thermometer and checklist (DT-NCCN), the Edmonton Symptom Assessment Scale (ESAS) and the Hospital Anxiety and Depression Scale (HADS). Consistent distress assessment is in keeping with the CCHSA Accreditation Program's standards on emotional distress: 7.9 The assessment includes processes to evaluate and monitor the client's emotional distress. 9.3 The client's service plan includes specific strategies to manage the client's pain & other symptoms.

  • Intervene to address distress once it is identified. Inform oneself about the resources available to address distress.

  • Advocate for consistent distress assessment and effective distress management.

  • Advocate for adequate resources to address distress. While the fiscal and human resource implications are significant for implementing a screening program for distress, the costs of doing nothing are also very high.

  • The ONS PEP (Putting Evidence into Practice) initiative identifies a number of evidence-based strategies that nurses can use to manage emotional distress. Please go to their web site for more information, www.ons.com

  • Submit a short article to CANO/ACIO Connections or the CONJ describing ways that nurses can help patients and their families manage emotional distress.

  • Help create a section on the CANO/ACIO web site that offers resources for assessing and managing distress. If this is of interest to you, please contact Vanessa Grieve the Director-at-Large, Education at Vanessa.grieve@sjghcomox.ca. We would love to hear from you regarding this type of project.

  • Build psychosocial distress into oncology nursing orientation and continuing education.

  • Participate in research opportunities with respect to psychosocial oncology.

  • Use the Advanced Practice Nurse as consultant for complex psychosocial care.

  • Advocate at a systems level to ensure psychosocial care is part of key structures; steering committee, supportive care committee.

  • Ensure proper assessment and management of symptoms or side effects of treatment as well.