title: Patient cues and symptoms of psychosocial distress: what predicts assessment and treatment of distress by oncology clinicians?
abstract: OBJECTIVE
  Psychosocial concerns arise after a cancer diagnosis and during treatment requiring oncology clinicians to initiate discussions to identify distress. This study examined patient-clinician communication about psychosocial concerns and predictors of assessment and treatment/referral for distress.
  
  
  METHODS
  Secondary analysis of existing dataset coded to explore patient-clinician communication during ambulatory visits in two comprehensive cancer centers was carried out. Sample included adult patients with various cancers and stages. Dataset included audio-recordings and symptom/QOL reports 4-6 weeks after starting treatment from all distressed patients (n = 66) in parent study and random sample of nondistressed patients (n = 23). Distressed patients had moderate-to-severe depression (Patient Health Questionnaire-9 scores ≥10) and/or poor emotional functioning (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire emotional function scores <50). Audio-recordings were coded to describe patient-clinician communication about psychosocial concerns using the coding scheme from the parent study plus Medical Interview Aural Rating System.
  
  
  RESULTS
  The remaining patients gave 222 cues of psychosocial concerns: 183 from 46 distressed patients and 39 from nine nondistressed patients. Distressed patients were younger, were female, had higher symptom burden, and/or gave more cues. Significantly, more distressed patients had at least one cue/visit. Clinicians initiated 62% of discussions overall with no statistical difference between distressed and nondistressed groups. More explicit cues and more than four cues predicted treatment/referral for distress.
  
  
  CONCLUSIONS
  Distressed patients were younger, were female, had higher symptom burden, and/or gave more verbal cues. Clinicians responded to explicit and more frequent cues by providing treatment and/or referrals for distress. Further exploration is needed regarding clinician factors related to assessment of psychosocial concerns.
authors.affiliation: University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Lisa Kennedy
authors.initials: LK
authors.lastname: Sheldon
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Traci M
authors.initials: TM
authors.lastname: Blonquist
authors.affiliation: University of Massachusetts Boston, Boston, MA, USA.
authors.forename: Dany M
authors.initials: DM
authors.lastname: Hilaire
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Fangxin
authors.initials: F
authors.lastname: Hong
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003463:Cues; D003863:Depression / Q000209:etiology*; D003865:Major Depressive Disorder / Q000209:etiology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D011237:Predictive Value of Tests; D011788:Quality of Life; D012017:Referral and Consultation; D012307:Risk Factors; D012737:Sex Factors; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy*
keywords: cancer; communication; distress; oncology; psychosocial factors; symptoms