A prospective validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to validate the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12) and Brief Symptom Inventory-18 (BSI-18) at baseline, four weeks and eight weeks. Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinically significant cut-off scores of the criterion measures reporting 95% confidence intervals. Standardised response means were used to compare DT scores with criterion measures over time. For a cut-off of 4 vs 5, sensitivity against HADS was 79%, specificity 81%; against GHQ-12, sensitivity was 63%, specificity 83%; and against BSI-18, sensitivity was 88%, specificity 74%. At both four and eight weeks, DT scores tended to change significantly in the same direction as the criterion measures. Ninety-five percent of patients found completing the DT acceptable. The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer. Our results indicate that it can be used to monitor change in psychological distress over time, but further work is needed to confirm this.

BackgroundProviding choice in health care is part of an ongoing policy initiative. AimTo explore how people understand choice in healthcare provision. Design of studyA qualitative study using semi-structured interviews. SettingSouth East England. MethodTwenty-two people were interviewed about the issue of choice in general, and choice in healthcare in particular. Data were analysed using template analysis. ResultsParticipants discussed choice in the NHS within the context of the GP consultation. Four main themes about choice were identified: positive aspects of choice; the appearance of choice; unwanted choice; and the role of information in choice. Participants valued choice in principle, and having choice was seen as positive. However, the provision of choice options was not always associated with the possibility of meaningful choice. Participants expressed that in some instances they were given the appearance rather than the substance of choice. Making -as opposed to having -choice was often unwanted and considered as indicative of erosion in trust in the GP. Information was seen as a necessary, but not sufficient, prerequisite of informed choice. ConclusionPeople value having choices rather than making choices but are concerned about choice provision for its own sake rather than choice that is available in a meaningful way. Health care policy that recommends an increase in choice per se may be met with scepticism which could ultimately undermine, rather than promote, the doctor-patient relationship. Keywordschoice; primary healthcare; qualitative research. INTRODUCTIONExtending consumer choice from the private to the public sector has been a key part of the government's modernising agenda.1 In 2004 the Department of Health explicitly located choice as a mechanism for improving health.2 Policies have been developed to embed patient choice across a number of areas of healthcare provision including the Choose and Book referral service, 3 and patients are now given a choice of hospital. 4 There is a commitment across political parties to extend the choice agenda, 5 and the value of choice is largely considered as selfevident: 'Who could argue against the desirability of allowing patients more say in decisions concerning their health? '. 6 Much research, particularly within the social sciences, emphasises the positive consequences of choice, such as enhancing enjoyment and task performance and producing more positive outcome evaluations (see Botti and Iyengar 7 for an overview). Such benefits seem to occur even which choice is illusory. 8 In contrast, Schwartz 9 in The Paradox of Choice drew attention to some of the negative consequences of choice in everyday life and suggested, for example, that a proliferation of options can render consumers anxious and overwhelmed. Similarly, Iyengar and Lepper 10 reported that many choices can result in decreased motivation to choose and lowered satisfaction. Research also indicates that the impact of choice may be especially negative when the psychological cons...

BackgroundCurrent policy advocates individual choice across a number of domains, including healthcare provision. AimTo develop a new tool for measuring people's beliefs about the value of choice in the context of healthcare provision. Design of studyCross-sectional survey. SettingFour general practices in South East England. MethodNine items relating to health and general domains, derived from in-depth interviews with 22 participants, were collated into a questionnaire. This formed the measurement tool called the Choice Questionnaire (ChQ), which was completed by 823 consecutive patients (response rate = 81.2%). ResultsPrincipal components analysis resulted in two factors: having choices (for example, 'I like to know all the possible ways in which I could be treated') and making choices (for example, 'I am happy for the doctor to make decisions for me'). These two constructs showed good internal consistency. One item was deleted, resulting in the 8-item ChQ. Beliefs about choice in health and general domains were not discrete. The vast majority of participants endorsed having choices as positive. In contrast, beliefs about the value of making choice were more mixed. A greater endorsement of both these aspects of choice was related to higher educational status. ConclusionResults from this study indicate that choice can be usefully conceptualised as consisting of two separate constructs: having choices and making choices. The 8-item ChQ has an interpretable factor structure and has been shown to be reliable. It could be used in research to assess beliefs about the value of choice or in the clinical setting to establish whether a patient would prefer to be provided with options or to be managed in a more paternalistic way. Keywordsbeliefs; choice behaviour; health care; questionnaire design. INTRODUCTIONAt the turn of this century, ex-Prime Minister Tony Blair and US President George Bush emphasised choice as a central component to reform. In line with this, Schwartz argued that choice has become a core component of modernisation.1 Furthermore, it has also penetrated the world of healthcare provision, with patients being referred to as 'consumers', and the production of the Patient's Charter, which emphasises each patients' right to choose how their health is managed. There is also focus on factors such as shared decision making, patient participation, and patient centredness. Central to this shift is the belief that choice is desirable, and economists and policy makers have conceptualised choice as 'something that one can't have too much of, like clean air or beauty'. 3The psychological literature also highlights the positive consequences of choice, indicating that greater choice increases intrinsic motivation, task performance, life skills, and higher outcome evaluations.4-8 Such benefits seem to occur regardless of whether choice is actual, trivial, or illusory. 9Researchers have also argued that individuals systematically prefer to take the choice option rather than the 'no-choice option'; this has bee...

Although policy emphasises the benefits of choice, an increasing body of work points to times when choice may not always have positive consequences. The present experimental study aimed to explore the impact of choice on a number of patient outcomes in the health care setting. The study also explored the extent to which the influence of choice was affected by patient uncertainty and anticipated regret. Choice was conceptualised as consisting of two dimensions: 'having choice' which reflects the availability of a number of options and 'making choice' reflecting resolution and a desire for a choice to be made. Consecutive patients (n = 427) from four General Practices in Surrey were asked to read one of 16 vignettes which varied in terms of four independent variables (having choice, making choice, uncertainty, anticipated regret) and to rate items relating to four outcome variables (patient satisfaction, perceived control, negative emotions, information seeking). The results showed that having more choice was consistently associated with more positive patient outcomes than having no choice. Having no choice was particularly detrimental for those experiencing anticipated regret and uncertainty. In contrast, whether or not a choice was made had no impact upon any of the outcome measures. In line with current policy having choice in the health care setting is related to improved patient outcomes. The results provide some insights into the factors which influence the direction of the impact of choice. They also indicate the importance of differentiating between 'having choice' and 'making choice'.