Screening for psychological distress in patients with lung cancer: results of a clinical audit evaluating the use of the patient Distress Thermometer

Abstract

PurposePatients with lung cancer frequently suffer psychological distress and guidelines in the United Kingdom recommend screening of all cancer patients for this problem. The audit investigated use of the Distress Thermometer in terms of staff adherence to locally developed guidelines, patient willingness to use the tool, its impact on referral rates to clinical psychology services and concordance between the tool and the clinical assessment.MethodUse of the Distress Thermometer was audited over a 3-month period in one lung cancer outpatient clinic. Referrals to clinical psychology services in response to clearly delineated referral indicators were assessed. Patient-reported outcomes were compared with practitioner assessment of need during clinical consultations to see whether the tool was measuring distress effectively.ResultsThirty three of 34 patients used the Distress Thermometer during the audit period. Ten reported distress levels above 4 in the emotional or family problems domains. On ten occasions, the clinical interview identified problems not elicited by the Distress Thermometer. Guidelines were adhered to by staff, and patients were offered information about local support services and referral to clinical psychology services where indicated. Whilst all patients were happy to receive written information about further sources of support, none wanted to be referred to psychological services at that time.ConclusionsThe Distress Thermometer is acceptable to patients with lung cancer in outpatient settings but it did not increase referrals for psychological support. Staff found it to be a useful tool in opening up communication about patient issues although it should not replace a comprehensive clinical interview.

The Association between Malnutrition and Psychological Distress in Patients with Advanced Head-and-Neck Cancer

“…Patients with reduced food intake or with more pain reported greater distress. Higher endorsement of psychosocial problems was associated with higher distress scores-a finding that is consistent with those in other studies 36,37 . Swallowing difficulties, low appetite, and mouth sores accompanied by pain were commonly endorsed by the 36% of patients with decreased food intake.…”

The Distress Management System for Stroke (DMSS): An approach for screening and initial intervention for post-stroke psychological distress

“…The Distress Management System (DMS) was designed to assess psychological distress in individuals with cancer, a condition that is often associated, like stroke, with high levels of emotional disturbance [25] . The DMS was devised to reduce the discomfort that individuals with cancer may have in acknowledging emotional difficulties on formal questionaires.…”

“…The DMS was devised to reduce the discomfort that individuals with cancer may have in acknowledging emotional difficulties on formal questionaires. The term 'distress' was chosen as a potentially less stigmatising alternative to 'anxiety' or 'depression', because it is a term that is less likely to pathologise the wide range of normal experiences associated with being diagnosed with cancer [25] . The DMS comprises two components, namely: (a) a 'Distress Thermometer'; and (b) a 'Concerns Checklist', which are now described in turn.…”

“…Although the DMS has been shown to be valid and practicable in cancer settings [25][26][27][28] , and has been identified as potentially useful for the stroke population [30] , there do not appear to be any published accounts that detail the adaptation of the system from cancer to stroke settings. Differences exist between cancer and stroke populations, and so it does not automatically follow that the same distress management approach, without modification, would be equally valid for both conditions.…”

Psychosocial Response and Symptom Burden for Male Smokers with Lung Cancer

“…So our study focused on the male smokers with lung cancer. Studies have given good general evidence that depression is a significant problem in lung cancer patients (Lynch et al, 2010;Sharp et al, 2013). And there have been many suggestions of a role for psychological response in the outcome of cancer (Watson et al, 2005;Messina et al, 2010;Knobf, 2011;Hoogerwerf et al, 2012).…”