title: The detection and management of emotional distress in cancer patients: the views of health-care professionals.
abstract: OBJECTIVE
  Emotional distress (ED) is an under-diagnosed problem in cancer patients and over the last decade a number of national guidelines have recommended an assessment and management model based on appropriate health professional response to a hierarchy of patient need. This study explores the views of cancer professionals regarding their current roles and responsibilities in the detection and management of ED, use of screening tools and access to expert psychological support.
  
  
  METHODS
  Interviews with 23 professionals were conducted [6 clinical nurse specialists (CNS), 8 oncologists, 4 surgeons and 5 ward sisters] from hospitals in Yorkshire, UK. Data were evaluated using framework analysis.
  
  
  RESULTS
  Detection of ED was seen to be the responsibility of the whole cancer team though nurses, particularly CNSs, are heavily depended upon to assess and manage distress. Experience of screening tools was limited and a number of reservations were expressed about routine implementation. A wide range of services are used to support distressed patients but a lack of referral guidance and access to specialist psychological care were reported to be a significant barrier to effective management.
  
  
  CONCLUSIONS
  Cancer professionals describe working within the fundamental principles of the guidance frameworks; however, access to specialist support do not appear to meet recommendations, leaving the CNS with considerable responsibility for the detection and management of ED. Support for ED may be improved by the introduction of routine screening along with appropriate training and implementation of referral guidelines to assist professionals in accessing specialist psychology services.
authors.affiliation: Cancer Research UK Psychosocial and Clinical Practice Research Group, St James's Institute of Oncology, Leeds, UK. k.l.absolom@leeds.ac.uk
authors.forename: Kate
authors.initials: K
authors.lastname: Absolom
authors.forename: Patricia
authors.initials: P
authors.lastname: Holch
authors.forename: Simon
authors.initials: S
authors.lastname: Pini
authors.forename: Kate
authors.initials: K
authors.lastname: Hill
authors.forename: Alan
authors.initials: A
authors.lastname: Liu
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.forename: Alison
authors.initials: A
authors.lastname: Richardson
authors.forename: Galina
authors.initials: G
authors.lastname: Velikova
mesh_terms: D000275:Adjustment Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D000328:Adult; D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D004739:England; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010348:Patient Care Team