"With our preventive approach to supportive care and early linkage of patients to appropriate resources, we aim to reduce barriers to psychosocial and palliative care, enhance patient participation in care and improve overall health."

The Distress Assessment and Response Tool (DART) is an innovative program developed by the Department of Supportive Care at Princess Margaret. Inspired by our commitment to provide patient-centred care that treats disease and supports the well-being of patients and their families, DART uses standardized, validated measures of physical distress, anxiety, depression and social difficulty and provides easy-to-read printouts for patients and their oncology team, with the ultimate goal of improving communication and the patient experience.

Every patient at Princess Margaret who is linked with our outpatient clinics has the opportunity to complete the self-assessment on touch-screen kiosks in waiting areas before their appointments. Specialized DART volunteers are on hand to help. A summary report is created and placed on the patient’s chart; the patient also receives a copy. These reports show clinically meaningful trends in symptoms over time.

DART asks patients specific questions about physical, emotional and practical difficulties that could interfere with their ability to engage in cancer treatment. For example, some people with cancer experience difficulty with everyday activities, including work, managing finances, childcare, housing, communicating with family, family planning, paying for medication and getting around. Other patients experience depression and anxiety or physical symptoms that require further assessment or management.

“In my practice, when I’ve gone into some of the patients’ clinic rooms, I’ve gone in with an assumption of the issues that we’re going to talk about that day. When I looked at the patient’s self-report, they identified issues that I had no idea they were struggling with and it certainly changed both the focus and the quality of our conversation that day.” –Barbara Fitzgerald, Director of Nursing

The DART report highlights these social, emotional, spiritual, informational, physical and practical needs and links them with a triaged response plan. A dedicated multidisciplinary team helps provide the right care at the right time.

Low-distress items are highlighted for a DART volunteer trained to provide basic information and peer support and to link patients to self-directed resources such as the Canadian Cancer Society or Wellspring.

Moderate to high distress is flagged for the nurse or oncologist, who then talks with the patient for further assessment and to create a personalized care plan, which could include a range of interventions from normalization and acknowledgement of concerns, to referral for specific services such as homecare support, medication coverage specialist or spiritual care.

In cases where patients are experiencing high levels of distress, the health care team considers referral to specialty supportive service, such as social work, psychiatry, and palliative care.

DART screens for suicidal ideation, an indication of underlying distress. Learn how to respond to suicidal ideation in cancer patients by watching “Suicidality: Tip of the DART Iceberg”, presented by Drs. Madeline Li and Sarah Hales.

Because DART is a universal screening process, it aims to remove bias, ensuring that all patients, no matter their age, race, ethnicity or other personal characteristics, have equal access to services and support throughout their cancer experience.

In our pilot study of the DART program, 88% of patients said they felt the program improved communication of symptoms and concerns to their health care team and nearly half said that participating in the program had a positive effect on them.

Information on DART for patients and families »

Last reviewed: 1/28/2021
Last modified: 1/29/2021 5:22 AM