National Comprehensive Cancer Network. (2012). NCCN clinical practice guidelines in oncology: Distress management [v.2.2013]. Retrieved from http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf

To provide clinical practice guidelines for the evaluation and treatment of distress — a normal feeling of vulnerability to a feeling that leads to disabling problems, such as depression and anxiety — in adult patients with cancer

• Evidence-based guidelines    
• Consensus development involving a panel composed of physicians, psychiatrists, psychologists, and social workers

• Phases of care: multiple phases 
• Clinical application: palliative care

Results were not stated.

Recommended standards of care include

• Screening all patients for distress, at initial visits and appropriate intervals
• Distress management according to guidelines
• Having committees to implement standards, provide relevant education and training to healthcare professionals
• Having mental health professionals and certified chaplains available
• Providing a distress-thermometer screening tool
• Identifying at-risk patients and periods of increased vulnerability, to define appropriate screening intervals

Evaluation should include measures relating to level of distress, behavior symptoms, psychiatric history and medications, pain and symptom control, body image and sexuality issues, impaired capacity, safety, potential medical causes, and psychological disorders.

Management algorithms should be provided for dementia, delirium, mood disorder, psychotic disorder, adjustment disorder, anxiety disorder, personality disorder, and substance-related disorder.

Treatments identified for use include psychotherapy, anxiolytics, antidepressants, psychoeducation, cognitive behavioral therapy, social work and counseling interventions, spiritual counseling and ethics, and palliative care consultation according to algorithms.

• The evidence is mainly \"lower level,\" and recommendations are primarily consensus-based. 
• The panel did not include a nursing member.
• Many recommendations tend to focus on approaches to care for patients with significant mental disorders or for those referred to a mental health team. 
• The guidelines provide limited suggestions regarding low-level distress associated with physical symptoms.

The guidelines provide recommended pathways regarding assessment and management of distress. They do not provide a nursing perspective or identify a role for nursing in patient management.