The Distress Thermometer (DT) is a well validated screening tool, demonstrably sensitive and reasonably specific to the construct of distress in cancer. Its brevity makes it ideal to incorporate into a system of distress management. To ascertain how far this idea has been developed in practice, and to support future research, a literature review was undertaken. Medline, CINAHL, PsycINFO, Embase, ASSIA, British Nursing Index, AMED, CCTR, and HMIC were systematically searched. Forty studies were reviewed that examined the function of the DT alone, together with the problem list (PL), and/or other validated measures. The majority of studies validated the DT against other robust measures of distress in order to establish 'caseness' in these populations, and establish factors associated with distress. Many of the studies recommended that further research should test their findings in clinical practice. A small section of the literature focused on the clinical utility of the DT as a facilitator of consultations, and found it to have potential in this regard. It is concluded that there is enough validation research, and in line with the majority of these studies' recommendations, future research should focus on the utility of DT as part of a structured distress management programme.

IntroductionPeople living with and beyond cancer are vulnerable to a number of physical, functional and psychological issues. Undertaking a holistic needs assessment (HNA) is one way to support a structured discussion of patients’ needs within a clinical consultation. However, there is little evidence on how HNA impacts on the dynamics of the clinical consultation. This study aims to establish (1) how HNA affects the type of conversation that goes on during a clinical consultation and (2) how these putative changes impact on shared decision-making and self-efficacy.Methods and analysisThe study is hosted by 10 outpatient oncology clinics in the West of Scotland and South West England. Participants are patients with a diagnosis of head and neck, breast, urological, gynaecological and colorectal cancer who have received treatment for their cancer. Patients are randomised to an intervention or control group. The control group entails standard care—routine consultation between the patient and clinician. In the intervention group, the patient completes a holistic needs assessment prior to consultation. The completed assessment is then given to the clinician where it informs a discussion based on the patient's needs and concerns as identified by them. The primary outcome measure is patient participation, as determined by dialogue ratio (DR) and preponderance of initiative (PI) within the consultation. The secondary outcome measures are shared decision-making and self-efficacy. It is hypothesised that HNA will be associated with greater patient participation within the consultation, and that shared decision-making and feelings of self-efficacy will increase as a function of the intervention.Ethics and disseminationThis study has been given a favourable opinion by the West of Scotland Research Ethics Committee and NHS Research & Development. Study findings will be disseminated through peer-reviewed publications and conference attendance.Trail registration numberClinical Trials.gov NCT02274701.

A variety of materials offering healthy eating advice have been produced in the United Kingdom to encourage people to eat well and avoid diet-related health issues. By applying a Foucauldian discourse analysis, this research aimed to uncover the discourses used in six healthy eating texts (two state-produced and four commercial texts), how people positioned themselves in relation to these discourses, and the power relations between institutions and the U.K. public. Ten discourses including scientific, thermodynamics, natural, family/caring, emotional, medical, and moral discourses were uncovered and offered up subject positions in relation to moral citizenship and personal responsibility. Through the use of biopower, foods appeared to be categorized as “good” or “bad” foods in which bad foods were considered to be risky to health due to their nutritional composition. Most texts assumed people have the agency to follow the advice provided and failed to consider the readers’ personal contexts.

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Despite global support for the ideal of shared decision making, its enactment remains difficult in practice. The UK charity, Macmillan Cancer Support, attempted to incorporate the principles of shared decision making within a programme of distress management in Scotland. Distress management begins by completing the Distress Thermometer (DT). Although the DT is a screening tool, its function in this programme was extended to facilitate collaborative communication within a consultation. The aim of this grounded theory was to analyse the patient experience of the process. Nineteen people underwent semi-structured interviews focused on their experience of distress management. Participants were a mixed-cancer cohort aged 40-79 years. Findings were discussed in a structured manner with a further 14 service users and carers, and 19 clinical specialists in cancer. Constant comparison of all data revealed that the process of positive distress management could best be explained by reference to the core category: 'helping the clinician help me'. The emergence of this core category is detailed by situating its development within the iterative nature of the grounded theory method.