title: Why do oncology outpatients who report emotional distress decline help?
abstract: OBJECTIVE
  Many patients who experience distress do not seek help, and little is known about the reasons for this. We explored the reasons for declining help among patients who had significant emotional distress.
  
  
  METHODS
  Data were collected through QUICATOUCH screening at an Australian hospital. Oncology outpatients scoring 4 or more on the Distress Thermometer were asked if they would 'like help' with their distress. Those who declined help were asked their reasons. Demographic variables and a clinical measure of anxiety and depression (PSYCH-6) were used to identify factors associated with reasons for declining help.
  
  
  RESULTS
  Of 311 patients with significant distress, 221 (71%) declined help. The most common reasons were 'I prefer to manage myself' (n = 99, 46%); 'already receiving help' (n = 52, 24%) and 'my distress is not severe enough' (n = 50, 23%). Younger patients and women were more likely to decline help and were more likely to already be receiving help. Distress score and PSYCH-6 scores were significantly lower among patients who rated their distress as not severe enough to require help. Nevertheless, there were patients who had maximal scores on distress and PSYCH in each group.
  
  
  CONCLUSIONS
  Two common patient barriers to help with distress are a preference for self-help and a belief that distress is not sufficiently severe to warrant intervention. These beliefs were held by a sizeable proportion of individuals who reported very high levels of distress. Qualitative research and subsequent interventions for overcoming these barriers are required to obtain the most benefit from distress screening programs.
authors.affiliation: Psycho-Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.|Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.|School of Psychology, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Kerrie Ann
authors.initials: KA
authors.lastname: Clover
authors.affiliation: Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicestershire, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Psycho-Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.|Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Britton
authors.affiliation: Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia.|Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000523:psychology* / Q000628:therapy; D001294:Attitude to Health; D001315:Australia; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology* / Q000628:therapy; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D012720:Severity of Illness Index; D012737:Sex Factors; D013315:Stress, Psychological / Q000523:psychology* / Q000628:therapy; D016312:Treatment Refusal / Q000523:psychology*
keywords: anxiety; cancer; depression; distress; help-seeking; oncology