Abstract
BackgroundUp to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model.MethodsConsecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call.ResultsThe Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care.ConclusionsOur data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.
Highlights
Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention
The current study aims to investigate the feasibility of detecting psychosocial morbidity for cancer patients and carers using the Distress Thermometer (DT), followed by appropriate referral, in a community-based telephone helpline setting
Reasons for non-participation included: 162 (25.0%) refusals; 40 (6.2%) callers were not asked to participate by operators; 53 (8.2%) callers had missing data related to their reason for refusal; 49 (7.6%) did not complete the additional data collection within 30 days; and three (0.5%) callers died before the additional data collection took place
Summary
Up to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. The service receives approximately 190 calls per week from cancer patients or carers and their most common requests include health-related information/resources, practice advice, and emotional support. A cut-off score of four on the DT yields optimal sensitivity and specificity in comparison with “caseness,” as established by the HADS [22,23,26] This cut-off has identified patients reporting high levels of physical, emotional, practical, and family problems [27,28,29]. The DT has been used in hospital and clinical contexts across a range of cancer diagnoses [16,21,22,25,29,31,32,33,34], there are no studies that have evaluated the measure’s utility in a communitybased helpline setting
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