Secondary Logo

Journal Logo


Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies

McCarter, Kristena,b,c,d,∗; Fradgley, Elizabeth A.a,b,c,d,∗; Britton, Bena,b,c,d,e; Tait, Jordana,d; Paul, Christinea,b,c,d

Author Information
Current Opinion in Supportive and Palliative Care: September 2020 - Volume 14 - Issue 3 - p 220-231
doi: 10.1097/SPC.0000000000000513
  • Open



Prevalence and impact of clinically significant distress for patients with cancer

Distress is an unpleasant emotional experience of a psychological, social, spiritual, and/or physical nature that interferes with the ability to cope effectively with cancer, its symptoms and treatment [1]. Approximately 52% of patients with cancer experience clinically significant distress [2]. Undetected or untreated distress in patients with cancer is associated with adverse outcomes ranging from reduced well being and quality of life (QOL [3–6]) to overall survival [7]. 

Box 1
Box 1:
no caption available

Basic components of distress screening and management pathways

Guidelines recommend distress screening and referral to supportive care services [4,8–14]. The minimum pathway components include: initial screening with a validated tool, further assessment to confirm the presence and source of distress, referral to supportive care services, and rescreening to determine referral uptake and if distress levels are unremitting or escalating.

Gaps in the current literature base

In order to impact patient outcomes and to provide guidance for services to integrate distress screening, implementation and quality improvement studies must include and evaluate the minimum components of the distress screening and management pathway and the strategies used to implement them. Pragmatic studies which utilize existing resources could provide exemplar models for implementation.

Review aims

There are numerous reviews [3,15–18], commentaries [19–22], and case-studies of distress management programs [23,24▪,25]. What none of these reviews offers is an overview of the various current approaches to implementing and reporting the minimum components of a distress screening and management program. This review seeks to answer:

Do recently published distress screening and management interventions in cancer align with basic guideline components (screening, assessment, referral, and rescreening) and provide sufficient detail on conduct and reporting to guide pragmatic integration into routine cancer care?


A rapid review was conducted following structured review methods to retrieve studies published between January 2018 and February 2020.

Inclusion criteria

The key inclusion criterion was distress or psychosocial screening for adult patients with cancer. The criteria used to determine eligibility for full-text inclusion are described below (Table 1).

Table 1
Table 1:
Inclusion and exclusion criteria

Search strategy

Key search terms were adapted from previously published systematic reviews of distress screening interventions [15,18]. Databases included Medline, EMBase, and PsycINFO with supplementary searches conducted in Google Scholar and five relevant journals (Table 2). All searches were completed by February 11, 2020.

Table 2
Table 2:
Search terms

Study selection and data extraction

Titles and abstracts were reviewed by three of the authors (KM, JT, EF) against inclusion criteria with a random 20% sample of articles double coded. Titles and abstracts from the hand-searched journals were assessed for eligibility by a third author (EF). The full texts were double coded (KM, JT) for eligibility with discrepancies resolved by discussion and a third reviewer (EF). Full text data were extracted independently by reviewers (KM, JT, EF) using a pilot-tested form. Figure 1 details the review process.

PRISMA flow diagram of review process.


Study characteristics

Twenty-two articles were included (Table 3 ). The majority of studies came from the United States (n = 8) and included outpatients or outpatient services.

Table 3
Table 3:
Study characteristics
Table 3 (Continued)
Table 3 (Continued):
Study characteristics

Minimum guideline components

Of the 22 reviewed studies, three articles [27,28,30] audited heterogeneous distress screening and management practices of multiple services as part of environmental scans or scoping studies. Two studies [36,47] focused on evaluation of a broader training or implementation program in which screening pathways were not outlined in full. These five studies are not included in the following section which focuses on the specific practices detailed in 17 studies [26,29,31–35,37▪▪,38,39▪▪,40–46] of distress screening and referrals programs:

Initial screening to identify the presence of distress

To align with basic screening components, the first step is the use of a brief validated distress screening tool with clinically meaningful cut-points [1,10].

Validated tools

Featured in 10 studies [31–34,39▪▪,40,42–45], the National Comprehensive Cancer Network (NCCN) distress thermometer was the most commonly used screening tool. However, the cut-points used to denote the presence of distress varied (range: distress thermometer ≥ 4–6). van Nuenen et al.[45] did not establish a cut-point with all health professionals directed to discuss the results regardless of the score. Similarly, van der Meulen et al.[44] prompted nurses to discuss the screening outcomes regardless of exceeding the cut-point.

Other validated tools reported included the Edmonton Symptom Assessment System (ESAS [29,46]), the Minimal Documentation System [41], the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) coupled with a study-specific tool [35], and the Questionnaire on Stress in Cancer Patients – Revised (QSC-R10 [38]). Adaptations to existing validated tools were also described in several studies [32,35,37▪▪].

The NCCN distress thermometer is well validated and has several advantages such as brevity and simplicity. However, it does not accurately measure the severity of distress. Second, it is a single global item and does not assess many of the symptoms which contribute to distress (e.g. nausea, fatigue, pain, anxiety). Examples of more inclusive tools include the ESAS, and this form of screening would provide additional value for health professionals to monitor and intervene on a wider set of symptoms.

Timing of initial screening

Ideally, patients should be screened for distress at each clinical encounter; however, there is ongoing debate about the feasibility and utility of this approach. Regardless, early introduction of distress screening can establish baseline severity, provide an opportunity for early intervention, and normalize the ongoing procedure for patients. Several studies initiated outpatient screening before treatment started [39▪▪] or at first or second appointments [26,31,32,34,37▪▪,40,42]. However, the time point of first screen was not clearly reported or established in several studies [29,41,43–46]. For three studies focused on inpatient distress, screening occurred upon admission [33,35,38]. Although Götz et al.[33] noted that the timing of initial screening shifted upon implementation with approximately 25% being screened at least 2 days after admission.

Health professional initiating screening

Many guidelines do not specify which health professional should initiate the screening procedure [39▪▪]. However, allocation of this clinical activity to specific individuals can ensure routine integration and may impact the feasibility and timeliness of the next steps in the distress management pathway. For example, care coordinators may be ideally placed to generate and action a wide variety of supportive care referrals. Of the 17 studies, seven studies did not report or clearly describe the qualification of the individual responsible for initiating the screening [26,29,31,35,37▪▪,38,46]. For the remaining studies, the majority of screening was initiated by nurses [33,39▪▪,40,42] or nurses in combination with social workers [43] or medical assistants [32,34,41].

Secondary assessment to confirm the presence and source of distress

Given the limited information provided by brief initial screening tools and concerns about the specificity of these tools [17,48], guidelines recommend that potentially distressed patients complete a more detailed assessment with clinical interview and/or a longer psychosocial measure [1,10]. It is important to note that this assessment was seldom described or completed as a two-step linear process in health services.

Confirmation and discussion of the screening results with the patient was described by 13 of the 17 studies with many reporting who discussed the results with patients (e.g. nurses [33,39▪▪,44] and/or physicians [31,34,41,42]). In some cases, screening results may have only been discussed when patients scored above the initial screening cut-point [26,37▪▪,39▪▪]. van Nuenen et al.[45] reported that initial screening results were discussed with 76% of 398 participants; Frey Nascimento et al.[31] found 54% of 333 patients self-reported discussing psychosocial distress with their oncologist. Ploos van Amstel et al.[39▪▪] reported that the screening results and nurses’ clinical judgement was discussed at a multidisciplinary team meeting.

Referral pathway

Distress management guidelines recommend screening results with clinical assessment should be used to match patients to supportive care services according to their level of distress. This is sometimes described as triaged or tiered supportive care. This triage process should be a formalized pathway to ensure access to finite supportive care services based on need (i.e. equitable) and reduce potential clinical variation across health professionals’ experience or expertise (i.e. consistent). The referral processes that were linked to screening results were included in 10 studies (Table 4 ).

Table 4
Table 4:
Tiered referral processes
Table 4 (Continued)
Table 4 (Continued):
Tiered referral processes

Several studies referenced a referral process but did not align or report referrals according to distress levels [42–46] with many of these basing referral according to patient wish or health professional judgement. For example, Tewes et al.[41] described a process whereby patients and physicians discussed screening results during the consultation; a psycho-oncologist and an oncologist specializing in palliative medicine also reviewed the results. Patients could indicate desire for a referral to outpatient palliative care services, psycho-oncology, social work, familial care, hospital, or pastoral care. The patient's oncologist was also contacted by the palliative care team if results suggested potential benefit. van Nuenen et al.[45] followed a similar model, the ‘Screening for Distress and Referral Need’ (SDRN) process. This included administering the distress thermometer and problem checklist, discussing responses with a health professional regardless of score, referral, providing information about distress thermometer and SDRN, and information on referral options and expertise of supportive care. A referral was offered to approximately 54% of all patients.


It is essential to rescreen all patients for distress given the potentially escalating and evolving nature of distress over time. Rescreening is also an opportunity to prompt distressed individuals who have not yet actioned referrals or to escalate the intervention intensity for patients with increasing or unremitting distress (e.g. stepped care). Only seven of the 17 studies described a rescreening procedure [32,33,35,39▪▪,44–46]; one of which rescreened moderately or severely distressed patients again after 7 days to evaluate the intervention [33]. Of note, the frequency at which repeat screens were completed by patients decreased over time as reported by van Nuenen et al.[45].

In summary, many studies did use a validated screening tool but did not follow subsequent pathway components: secondary assessment (13/17 studies); referral pathway (10/17 studies) linked to screening results; and rescreening (7/17 studies). It is important to note that the described components were not audited for quality as part of this review.


Nine of the 22 articles indicated that their studies included implementation of a distress screening program (e.g. ‘implemented screening processes for distress, and subsequent referral processes’) [26,29,32,34–36,37▪▪,46,47]. This was distinct from the remaining studies that solely described adherence [33], effectiveness for improving QOL [39▪▪], referral uptake [31,38], patient needs [41], patient experiences [45], feasibility [40,43,44], an audit/survey of practices [27,28,30,42] of a distress screening protocol.

The Cochrane Effective Practice and Organization of Care (EPOC) taxonomy [49] is a framework for categorizing implementation strategies. The EPOC subcategories identified within each of these studies are provided in Table 5. Of the nine studies deemed to include some description of implementation of a distress screening program, seven studies reported strategies ranging from single component through to comprehensive multicomponent interventions [26,32,35,36,37▪▪,47]. Two of the nine studies that described putting into effect a new distress screening program (i.e. implementation) did not describe use of any of these or other fundamental implementation strategies nor was there a clear description of anything that could be identified as an implementation strategy using the EPOC taxonomy [34,36].

Table 5
Table 5:
EPOC implementation strategies used in included studies

Descriptions of implementation varied greatly in regard to labelling and defining strategies which made identification of implementation strategies difficult. We identified seven of the EPOC strategies within both Fitch et al., [29] and Pearson and Melton [37▪▪] by applying the EPOC subcategory definitions. However, it was unclear which of the Fitch et al.[29] description of recommended implementation strategies were actually put into practice. Pearson and Melton [37▪▪] described a comprehensive set of strategies included within the evolving development of an oncology distress screening program that included training and materials, a working group and an iterative feedback and development process, development of a formal Oncology Distress Screening Policy and buy-in and support from clinic managers and leaders. Several studies mentioned implementation strategies but did not provide detail [26,32,34,35,46]. For example, Geske and Johnson [32] evaluated a US cancer institute's adaptation of NCCN guidelines in implementing a new administration protocol of the distress thermometer and electronic referrals within the medical record. The discussion section of the paper noted that staff were provided with their local referral rates (audit and feedback [32]). In another study, despite comparing the number of referrals before and after implementation of electronic screening for psycho-oncological treatment needs, the only applicable EPOC strategy that could be identified (Loth et al.[35]) was the ‘need-based interprofessional implementation procedure of modifications’ to the screening tool to ‘adapt it to clinical requirements’ (local consensus processes with department clinical staff).

Implementation strategies have enormous importance in the field of supportive care in cancer. However, progression of successful routine distress screening and referral programs in cancer is hindered as we are not able to fully interpret nor utilize the findings of existing studies. Researchers and clinicians are unable to determine whether studies simply did not employ an implementation strategy(s) or failed to adequately report them. Justification and evidence for selected implementation strategies were scarce.

Of the seven studies (of the nine included in this section) reporting implementation strategies, only two included any evidence-based rationale for their selections. Zebrack et al.[47] cited quality in healthcare research papers in their description of audit and feedback of results from individual institutions performance according to prescribed psychosocial screening protocols. Contrastingly, McLeod et al.[36] made clear justifications for their complex intervention, citing specific evidence-based knowledge translation research within oncology in relation to their numerous implementation strategies, including that around tailored interventions [50,51], supervision [52,53], and buy-in from cancer care leaders and stakeholders [54].

Recommendations for future research

Distress screening and management programs are recommended by national and international guidelines as a key component of comprehensive cancer care. Therefore, clinicians and policy makers should be confident in integrating this pathway into routine practice. However, there remains a lack of guidance for pragmatic implementation because of a number of issues regarding conduct and reporting of studies:

  • (1) Numerous guidelines recommend similar minimum components for distress screening and management pathways. Testing of the basic elements has been neglected and often nonsignificant results are reported. Researchers should take care to design studies that include these minimum components in order for the field to advance.
  • (2) Effective implementation interventions cannot be identified, evaluated, replicated and disseminated without a full description of their components and how they should be used. Examples of implementation strategies should therefore be clearly specified (named and defined, dose specified, the implementation outcome targeted and affected). There are several relevant reporting guidelines including Standards for Reporting Implementation Studies Statement [55], Workgroup for Intervention Development and Evaluation Research recommendations [56], and Standards for Quality Improvement Reporting Excellence [57].
  • (3) We must have successful models to guide implementation. The field of implementation science can assist our efforts. For example, multicomponent implementation interventions to improve depression or anxiety screening in primary care are more effective in improving provision of care [58–60]. Any chosen strategy/ies for implementation of distress screening and management programs in cancer care should be evidence based and justified as such.


Many recently published distress screening and management interventions in cancer do not appear to align with minimum recommended clinical guideline components nor do they provide sufficient detail on implementation to guide pragmatic integration into routine cancer care. Attention to these factors is needed in the design and reporting of future studies if we are to realize the potential benefits of these programs for patients with cancer.


This research has received support from the Hunter Cancer Research Alliance (HCRA). HCRA receives funding from the Cancer Institute NSW to operate as a Translational Cancer Research Centre in partnership with the University of Newcastle, Hunter Medical Research Institute, Hunter New England Local Health District and Calvary Mater Newcastle.

Disclosure of funding received for this work: None.

Financial support and sponsorship

No financial support specifically supported the preparation of this review. E.F. was supported by a Cancer Institute of New South Wales Early Career Fellowship. B.B. was supported by a Clinical Research Fellowship from the Hunter Cancer Research Alliance

Conflicts of interest

There are no conflicts of interest.


Papers of particular interest, published within the annual period of review, have been highlighted as:


1. Riba MB, Donovan KA, Andersen B, et al. Distress management, version 3.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2019; 17:1229–1249.
2. Mehnert A, Hartung TJ, Friedrich M, et al. One in two cancer patients is significantly distressed: prevalence and indicators of distress. Psychooncology 2018; 27:75–82.
3. Carlson LE, Waller A, Mitchell AJ. Screening for distress and unmet needs in patients with cancer: review and recommendations. J Clin Oncol 2012; 30:1160–1177.
4. Watson L, Groff S, Tamagawa R, et al. Evaluating the impact of provincial implementation of screening for distress on quality of life, symptom reports, and psychosocial well being in patients with cancer. J Natl Compr Canc Netw 2016; 14:164–172.
5. Bornbaum CC, Fung K, Franklin JH, et al. A descriptive analysis of the relationship between quality of life and distress in individuals with head and neck cancer. Support Care Cancer 2012; 20:2157–2165.
6. Krebber A-MH, Jansen F, Witte B, et al. Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial. Ann Oncol 2016; 27:1754–1760.
7. Kim GM, Kim SJ, Song SK, et al. Prevalence and prognostic implications of psychological distress in patients with gastric cancer. BMC Cancer 2017; 17:283.
8. Russ TC, Stamatakis E, Hamer M, et al. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 2012; 345:e4933.
9. Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605–1619.
10. Butow P, Price MA, Shaw JM, et al. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psychooncology 2015; 24:987–1001.
11. Howell D, Keshavarz H, Esplen M, et al. Pan-Canadian practice guideline: Screening, assessment and management of psychosocial distress, major depression and anxiety in adults with cancer. Canadian Association of Psychosocial Oncology and Canadian Partnership Against Cancer, Toronto 2015; [Accessed 18 March 2020].
12. Carlson LE, Groff SL, Maciejewski O, Bultz BD. Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol 2010; 28:4884–4891.
13. Carlson LE, Waller A, Groff S, et al. Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage. Br J Cancer 2012; 107:617–625.
14. Carlson LE, Waller A, Groff SL, Bultz BD. Screening for distress, the sixth vital sign, in lung cancer patients: effects on pain, fatigue, and common problems—secondary outcomes of a randomized controlled trial. Psychooncology 2013; 22:1880–1888.
15. McCarter K, Britton B, Baker AL, et al. Interventions to improve screening and appropriate referral of patients with cancer for psychosocial distress: systematic review. BMJ Open 2018; 8:e017959.
16. Meijer A, Roseman M, Delisle VC, et al. Effects of screening for psychological distress on patient outcomes in cancer: a systematic review. J Psychosom Res 2013; 75:1–17.
17. Mitchell AJ. Screening for cancer-related distress: when is implementation successful and when is it unsuccessful? Acta Oncol 2013; 52:216–224.
18. Schouten B, Avau B, Bekkering P, et al. Systematic screening and assessment of psychosocial well being and care needs of people with cancer. Cochrane Database Syst Rev 2019; 3:CD012387.
19. Jacobsen PB, Norton WE. The role of implementation science in improving distress assessment and management in oncology: a commentary on ‘Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship’. Transl Behav Med 2019; 9:292–295.
20. Nissen KG. Commentary: psychosocial screening and assessment in oncology and palliative care settings. Front Psychol 2015; 6:1223.
21. Palmer SC. If we build it, they will come: rethinking some assumptions about screening and intervening for distress. J Natl Compr Canc Netw 2019; 17:1017–1018.
22. Rana R, Latif S, Gururajan R, et al. Automated screening for distress: a perspective for the future. Eur J Cancer Care (Engl) 2019; 28:e13033.
23. Bergerot CD, Battle D, Staehler MD, Pal SK. Distress in patients with renal cell carcinoma: a curious gap in knowledge. BJU Int 2019; 123:208–209.
24▪. Ehlers SL, Davis K, Bluethmann SM, et al. Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship. Transl Behav Med 2019; 9:282–291.
25. Smith SK, Loscalzo M, Mayer C, Rosenstein DL. Best practices in oncology distress management: beyond the screen. Am Soc Clin Oncol Educ Book 2018; 38:813–821.
26. Acquati C, Kayser K. Addressing the psychosocial needs of cancer patients: a retrospective analysis of a distress screening and management protocol in clinical care. J Psychosoc Oncol 2019; 37:287–300.
27. Cartmell KB, Sterba KR, Pickett K, et al. Availability of patient-centered cancer support services: a statewide survey of cancer centers. PLoS One 2018; 13:e0194649.
28. Ernstmann N, Enders A, Halbach S, et al. Psycho-oncology care in breast cancer centres: a nationwide survey. BMJ Support Palliat Care 2019; 0:1–4. doi: 10.1136/bmjspcare-2018-001704.
29. Fitch MI, Ashbury F, Nicoll I. Reflections on the implementation of screening for distress (sixth vital sign) in Canada: key lessons learned. Support Care Cancer 2018; 26:4011–4020.
30. Fradgley EA, Byrnes E, McCarter K, et al. A cross-sectional audit of current practices and areas for improvement of distress screening and management in Australian cancer services: is there a will and a way to improve? Support Care Cancer 2020; 28:249–259.
31. Frey Nascimento A, Tondorf T, Rothschild SI, et al. Oncologist recommendation matters!—Predictors of psycho-oncological service uptake in oncology outpatients. Psychooncology 2019; 28:351–357.
32. Geske SJ, Johnson RL. Using the distress thermometer to guide electronic referrals to psychosocial services. J Psychosoc Oncol 2020; 38:20–35.
33. Götz A, Kröner A, Jenewein J, Spirig R. Evaluation of the adherence of distress screening with the distress thermometer in cancer patients 4 years after implementation. Support Care Cancer 2019; 27:2799–2807.
34. Hamilton J, Kroska EB. Distress predicts utilization of psychosocial health services in oncology patients. Psychooncology 2019; 28:61–67.
35. Loth FL, Meraner V, Holzner B, et al. Following patient pathways to psycho-oncological treatment: Identification of treatment needs by clinical staff and electronic screening. Psychooncology 2018; 27:1312–1319.
36. McLeod D, Esplen MJ, Wong J, et al. Enhancing clinical practice in the management of distress: the Therapeutic Practices for Distress Management (TPDM) project. Psychooncology 2018; 27:2289–2295.
37▪▪. Pearson M, Melton LM. Implementing oncology distress screening in a large academic health system. Oncology Issues 2020; 35:46–51.
38. Pichler T, Dinkel A, Marten-Mittag B, et al. Factors associated with the decline of psychological support in hospitalized patients with cancer. Psychooncology 2019; 28:2049–2059.
39▪▪. Ploos van Amstel FK, Peters ME, Donders RA, et al. Does a regular nurse-led distress screening and discussion improve quality of life of breast cancer patients treated with curative intent? A randomized controlled trial. Psychooncology 2020; 29:719–728.
40. Swanson AJ, Castel LD, McKenna PA, et al. Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management. Prof Case Manag 2019; 24:148–154.
41. Tewes M, Rettler T, Wolf N, et al. Predictors of outpatients’ request for palliative care service at a medical oncology clinic of a German comprehensive cancer center. Support Care Cancer 2018; 26:3641–3647.
42. Tondorf T, Grossert A, Rothschild SI, et al. Focusing on cancer patients’ intentions to use psychooncological support: a longitudinal, mixed-methods study. Psychooncology 2018; 27:1656–1663.
43. Tonsing KN, Vungkhanching M. Assessing psychological distress in cancer patients: the use of distress thermometer in an outpatient cancer/hematology treatment center. Soc Work Healthcare 2018; 57:126–136.
44. van der Meulen IC, May AM, Koole R, Ros WJ. A distress thermometer intervention for patients with head and neck cancer. Oncol Nurs Forum 2018; 45:E14–E32.
45. van Nuenen FM, Donofrio SM, van de Wiel HBM, Hoekstra-Weebers J. Cancer patients’ experiences with and opinions on the process 'Screening of Distress and Referral Need’ (SDRN) in clinical practice: a quantitative observational clinical study. PLoS One 2018; 13:e0198722.
46. Walker LM, Villiger MP, Robinson JW. Assessing the utility of a distress screening tool at capturing sexual concerns in a gyne-oncology follow-up clinic. Support Care Cancer 2018; 26:887–893.
47. Zebrack B, Kayser K, Oktay J, et al. The Association of Oncology Social Work's Project to Assure Quality Cancer Care (APAQCC). J Psychosoc Oncol 2018; 36:19–30.
48. Mitchell AJ. Short screening tools for cancer-related distress: a review and diagnostic validity meta-analysis. J Natl Compr Canc Netw 2010; 8:487–494.
49. Effective Practice and Organisation of Care (EPOC). EPOC Taxonomy 2015; Available online at: [Accessed 19 March 2020].
50. Cummings GG, Olivo SA, Biondo PD, et al. Effectiveness of knowledge translation interventions to improve cancer pain management. J Pain Symptom Manage 2011; 41:915–939.
51. Hack TF, Carlson L, Butler L, et al. Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care. Support Care Cancer 2011; 19:1097–1105.
52. Heaven C, Clegg J, Maguire P. Transfer of communication skills training from workshop to workplace: the impact of clinical supervision. Patient Educ Couns 2006; 60:313–325.
53. Turner J, Mackenzie L, Kelly B, et al. Building psychosocial capacity through training of front-line health professionals to provide brief therapy: lessons learned from the PROMPT study. Support Care Cancer 2018; 26:1105–1112.
54. Lazenby M, Ercolano E, Grant M, et al. Supporting commission on cancer–mandated psychosocial distress screening with implementation strategies. J Oncol Pract 2015; 11:e413–e420.
55. Pinnock H, Barwick M, Carpenter CR, et al. Standards for reporting implementation studies (StaRI) statement. BMJ 2017; 356:i6795.
56. Albrecht L, Archibald M, Arseneau D, Scott SD. Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations. Implement Sci 2013; 8:52.
57. Ogrinc G, Davies L, Goodman D, et al. Standards for QUality Improvement Reporting Excellence 2.0: revised publication guidelines from a detailed consensus process. J Surg Res 2016; 200:676–682.
58. Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. Jama 2003; 289:3145–3151.
59. Heideman J, van Rijswijk E, van Lin N, et al. Interventions to improve management of anxiety disorders in general practice: a systematic review. Br J Gen Pract 2005; 55:867–874.
60. Hermanns N, Caputo S, Dzida G, et al. Screening, evaluation and management of depression in people with diabetes in primary care. Prim Care Diab 2013; 7:1–10.

Kristen McCarter and Elizabeth A. Fradgley are to be listed as co-first authors.


cancer; distress; guidelines; implementation; intervention

Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.