which addresses the management of distress (NCCN, 2007a). NCCN’s consensus-based distress guidelines call for (1) screening of all patients at their initial visit, at appropriate intervals, and as clinically indicated to determine the level and nature of distress; (2) further evaluation, triage, and referral of patients with significant distress to appropriate resources for care; and (3) education of patients and their families about distress and its management (NCCN, 2006).
Australia’s Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer were developed from a systematic review of research evidence. Although most of the guidelines address how to care for individual symptoms, such as anxiety, or practical problems, such as financial or work-related concerns, the guidelines also recommend certain cross-cutting activities to be carried out in treatment settings. These activities include providing patients with information to support their decision making, screening all patients for clinically significant anxiety and depression, ensuring continuity of care through the designation of a person responsible for care coordination, and developing referral pathways and networks (National Breast Cancer Centre and National Cancer Control Initiative, 2003).
The National Institute for Clinical Excellence (NICE) in the United Kingdom has promulgated guidance on improving supportive and palliative care for adults with cancer. The specific model of care delivery put forth in this guidance is difficult to generalize to the United States because it is based on an infrastructure for cancer care specific to the United Kingdom, such as designated Cancer Networks22 for specific geographic areas charged with delivering components of a comprehensive National Cancer Plan. However, NICE’s guidance recommends the performance of certain generic activities as part of its model for delivering supportive and palliative services, including assessment of patients’ psychological, social, spiritual, and financial support needs alongside an assessment of physical needs; promotion of continuity and coordination of care through such mechanisms as multidisciplinary teams and interprofessional communication strategies; systems to support patients and their caregivers in participating in care; provision of