title: Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: randomised controlled trial of computerised vs personalised triage.
abstract: BACKGROUND
  This randomised controlled trial examined the impact of screening for distress followed by two different triage methods on clinically relevant outcomes over a 12-month period.
  
  
  METHODS
  Newly diagnosed patients attending a large tertiary cancer centre were randomised to one of the two conditions: (1) screening with computerised triage or (2) screening with personalised triage, both following standardised clinical triage algorithms. Patients completed the Distress Thermometer, Pain and Fatigue Thermometers, the Psychological Screen for Cancer (PSSCAN) Part C and questions on resource utilisation at baseline, 3, 6 and 12 months.
  
  
  RESULTS
  In all, 3133 patients provided baseline data (67% of new patients); with 1709 (54.5%) retained at 12 months (15.4% deceased). Mixed effects models revealed that both groups experienced significant decreases in distress, anxiety, depression, pain and fatigue over time. People receiving personalised triage and people reporting higher symptom burden were more likely to access services, which was subsequently related to greater decreases in distress, anxiety and depression. Women may benefit more from personalised triage, whereas men may benefit more from a computerised triage model.
  
  
  CONCLUSIONS
  Screening for distress is a viable intervention that has the potential to decrease symptom burden up to 12 months post diagnosis. The best model of screening may be to incorporate personalised triage for patients indicating high levels of depression and anxiety while providing computerised triage for others.
authors: Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services-Cancer Care Holy Cross Site, 2202 2nd Street SW, Calgary, Alberta, Canada T2S 3C1. lcarlso@ucalgary.ca
authors: L E
authors: LE
authors: Carlson
authors: A
authors: A
authors: Waller
authors: S L
authors: SL
authors: Groff
authors: L
authors: L
authors: Zhong
authors: B D
authors: BD
authors: Bultz
mesh_terms: D000465:Algorithms; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy; D003201:Computers; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010358:Patient Participation; D012737:Sex Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*