Which items on the distress thermometer problem list are the most distressing?
The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress.



Oncology outpatients (n = 1066) undergoing QUICATOUCH screening in an Australian cancer centre completed the distress thermometer (DT) and problem list (PL). Principal component analysis (PCA), logistic regression and classification and regression tree (CART) analyses tested the relationship between DT score (at a cut-off point of 4) and PL items.



Sixteen items were reported by <5 % of participants. PCA analysis identified four major components. Logistic regression analysis indicated three of these component scores, and four individual items (20 items in total) demonstrated a significant independent relationship with distress. The best CART model contained only two PL items: 'worry' and 'depression'.



The DT and PL function as intended, quantifying negative emotional experience (distress) and identifying bio-psychosocial sources of distress. We offer two suggestions to minimise PL response time whilst targeting PL items most related to distress, thereby increasing clinical utility. To identify patients who might require specialised psychological services, we suggest the DT followed by a short, case-finding instrument for patients over threshold on the DT. To identify other important sources of distress, we suggest using a modified PL of 14 key items, with the 15th item 'any other problem' as a simple safety net question. Shorter times for patient completion and clinician response to endorsed PL items will maximise acceptance and clinical utility.
Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia. kerrie.clover@calvarymater.org.au.|Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia. kerrie.clover@calvarymater.org.au.
Kerrie Ann
KA
Clover
Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia.
Christopher
C
Oldmeadow
Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia.
Louise
L
Nelson
Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia.
Kerry
K
Rogers
Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicester, UK.
Alex J
AJ
Mitchell
Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia.|Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia.
Gregory
G
Carter
D001007:Anxiety / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D025341:Principal Component Analysis / Q000379:methods*; D013315:Stress, Psychological / Q000523:psychology*
Anxiety; Depression; Distress; Neoplasms; Psychology