Successful strategies for implementing biopsychosocial screening

OBJECTIVE: This commentary integrates successful screening implementation strategies applied in four institutions in the United States and the accumulated knowledge from international leaders about how to engage key professionals and administration in partnering to create a culture of screening. METHODS: As in clinical practice, it is first necessary to know the patient's story, potential resources and what motivates them to coordinated meaningful action. Introducing a comprehensive program of screening shares similarities with clinical care but also requires additional insights and an understanding of what motivates institutions to make resources available. Specific behaviors that are tailored to the values of particular professions and the institution are described to increase the likelihood of program uptake. Once key professionals and administration understand the value of screening and not before, a screening implementation plan is put into place. RESULTS: Since the 1990s our screening programs have been successfully implemented in four settings: three NCI Designated Comprehensive Cancer Centers and one community hospital. It is estimated that more than 15,000 cancer outpatients have been screened for distress and cancer-related problems. These programs have demonstrated that biopsychosocial screening programs can be integrated into busy outpatient cancer clinics as part of standard clinical care. CONCLUSIONS: Screening involves an intervention that impacts patients, clinical systems, the institution and staffing levels of psychosocial providers. Provision of scarce resources, active engagement of key professionals and administration will only occur if the stakeholders have a clear sense of the benefits for them. Implementing a screening program creates culture change and culture change not only takes time, but active engagement, patience and persistence.