title: Are needs assessments cost effective in reducing distress among patients with cancer? A randomized controlled trial using the Distress Thermometer and Problem List.
abstract: OBJECTIVE
  Patients with cancer have a high prevalence of distress. We evaluated whether distress monitoring and needs assessment using the Distress Thermometer and Problem List (DT&PL) improved patient outcomes.
  
  
  METHODS
  We conducted an unblinded, two-arm, parallel randomized controlled trial at two sites among patients starting radiotherapy or chemotherapy. The intervention group completed the DT&PL, rating distress and discussing sources of distress with a trained radiographer/nurse. No specific triage algorithms were followed. The control group received usual care. The main outcome measure was psychological distress (Profile of Mood States [POMS], short form) up to 12 months; secondary outcomes were quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30) and health care costs.
  
  
  RESULTS
  Of 220 patients randomly assigned, 112 patients were allocated to the DT&PL. Ninety-five percent completed the primary outcome at 12 months. The DT&PL took 25 minutes; one third of patients had high levels of distress, and most reported physical (84%) or emotional (56%) problems. There was no evidence of an effect of the DT&PL on adjusted POMS scores over follow-up (difference between groups, -1.84; 95% CI, -5.69 to 2.01; P = .35) or in secondary outcomes. The DT&PL cost £19 ($28) per patient and did not lower subsequent health care costs. Few patients (< 3%) in either arm of the trial were referred to a clinical psychologist.
  
  
  CONCLUSIONS
  Patients with cancer have a high prevalence of distress. Needs assessment can be performed quickly and inexpensively. However, the DT&PL was not cost effective in improving patient mood states. It is important to explore the reasons for this so that oncology units can design better services to support patients.
authors.affiliation: William Hollingworth, Chris Metcalfe, Susan Harris, Rona Campbell, Lucy Biddle, Denise McKell-Redwood, and James Brennan, University of Bristol; James Brennan, University Hospitals Bristol National Health Service Foundation Trust, Bristol; and Susana Mancero, Royal United Hospital Bath National Health Service Trust, Bath, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
authors.forename: Chris
authors.initials: C
authors.lastname: Metcalfe
authors.forename: Susana
authors.initials: S
authors.lastname: Mancero
authors.forename: Susan
authors.initials: S
authors.lastname: Harris
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
authors.forename: Lucy
authors.initials: L
authors.lastname: Biddle
authors.forename: Denise
authors.initials: D
authors.lastname: McKell-Redwood
authors.forename: James
authors.initials: J
authors.lastname: Brennan
mesh_terms: D003362:Cost-Benefit Analysis; D006801:Humans; D020380:Needs Assessment; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D011788:Quality of Life; D013315:Stress, Psychological / Q000175:diagnosis / Q000517:prevention & control*