The sixth vital sign
AHFMR Health Scholar Dr. Linda Carlson envisions a day when "Check their distress level" is heard as frequently as "Check their blood pressure" in cancer centres. "Emotional distress is as much an indicator of a patient's health and well-being as the standard vital signs of temperature, respiration, heart rate, blood pressure, and pain [a recent addition to the list]. We need to recognize this in the care of cancer patients."
The concept of emotional distress as the "sixth vital sign" was pioneered by Dr. Carlson's colleague Dr. Barry Bultz. Both Dr. Carlson and Dr. Bultz are clinical psychologists in the Department of Psychosocial Resources at the Tom Baker Cancer Centre in Calgary. Their research and that of others has demonstrated that emotional distress is a significant problem for one-third to one-half of all cancer patients. It is believed that treating emotional distress will benefit not only patients but also their families and the cancer-care system itself. Patients who are distressed demand more time and resources than average from an already overburdened system.
So what is the most effective way to help cancer patients cope with distress? Dr. Carlson is studying this question by means of a major project in which patients are screened for evidence of distress. Since 2006, first-time patients at the Tom Baker Cancer Centre have been directed to a kiosk to fill out the Personal Well-being Checklist, in which they answer a variety of questions about stress levels, anxiety, depression, sleep, and fatigue, as well as questions about common practical problems such as drug coverage and finances. The questionnaire is used as a screening tool for distress, to identify problem areas. Dr. Carlson's research tests two approaches to acting on this information: computerized and personalized. One approach has a patient receiving a computerized printout that summarizes the individual's screening results and, based on those results, lists resources available within the centre that the patient can call upon for help. The second approach relays the same information in a personal phone call from a trained assistant, who then helps the patient set up appointments if any are requested.
There are already more than 3,000 people in the database, and recruitment will continue until late 2008. Staff contact patients after 3, 6, and 12 months to check on their levels of distress and anxiety, and to find out which recommendations and referrals they pursued. The study also monitors the costs (to the system) incurred by each patient in terms of prescriptions for drugs and visits to doctors. Dr. Carlson expects to have the results, including those from the 12-month follow-up, by late 2009.
"The problem with the current system is that it's hit-and-miss when it comes to dealing with distress," explains Dr. Carlson. "People might get help or they might not. Not everyone is resourceful or has the same access to resources. This is a way of being systematic about it. The idea is that by directing everyone to the appropriate support services at the start, we could avoid some of the problems later on.
"Ideas are changing-we're recognizing that the 'people part' of cancer care is as important as treating the disease itself. I'm proud to say that we in Alberta are leaders in this aspect. This is becoming an even bigger issue as more patients become cancer survivors and more live with cancer as a chronic disease. Neglecting emotional distress creates a gap in care. We're moving to a continuity of cancer care that is holistic, not piecemeal."