title: Easier Said Than Done: Keys to Successful Implementation of the Distress Assessment and Response Tool (DART) Program.
abstract: Systematic screening for distress in oncology clinics has gained increasing acceptance as a means to improve cancer care, but its implementation poses enormous challenges. We describe the development and implementation of the Distress Assessment and Response Tool (DART) program in a large urban comprehensive cancer center.
  
  
  
  DART is an electronic screening tool used to detect physical and emotional distress and practical concerns and is linked to triaged interprofessional collaborative care pathways. The implementation of DART depended on clinician education, technological innovation, transparent communication, and an evaluation framework based on principles of change management and quality improvement.
  
  
  
  There have been 364,378 DART surveys completed since 2010, with a sustained screening rate of > 70% for the past 3 years. High staff satisfaction, increased perception of teamwork, greater clinical attention to the psychosocial needs of patients, patient-clinician communication, and patient satisfaction with care were demonstrated without a resultant increase in referrals to specialized psychosocial services. DART is now a standard of care for all patients attending the cancer center and a quality performance indicator for the organization.
  
  
  
  Key factors in the success of DART implementation were the adoption of a programmatic approach, strong institutional commitment, and a primary focus on clinic-based response. We have demonstrated that large-scale routine screening for distress in a cancer center is achievable and has the potential to enhance the cancer care experience for both patients and staff.
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada madeline.li@uhn.ca.
authors.forename: Madeline
authors.initials: M
authors.lastname: Li
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Macedo
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Crawford
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Sabira
authors.initials: S
authors.lastname: Bagha
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Leung
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fitzgerald
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Martha
authors.initials: M
authors.lastname: Wyatt
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Terri
authors.initials: T
authors.lastname: Stuart-McEwan
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; University of Toronto, Toronto, Ontario; and BC Children's and Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
mesh_terms: D002173:Cancer Care Facilities; D003142:Communication; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013315:Stress, Psychological; D011795:Surveys and Questionnaires