title: Patients' and clinicians' experiences of holistic needs assessment using a cancer distress thermometer and problem list: A qualitative study.
abstract: OBJECTIVE
  Psychosocial needs assessment is recommended for patients undergoing cancer treatment, but trials of effectiveness of assessment tools provide mixed results. This qualitative study aimed to understand how such tools are experienced by patients and clinicians in order to optimise use in the future.
  
  
  METHODS
  Qualitative interviews were used in a mixed-methods sequential design following a randomised controlled trial of needs assessment using the Distress Thermometer and Problem List (DT&PL), and explored patients' and clinicians' evaluations of the needs assessment process.
  
  
  RESULTS
  Benefits of needs assessment using the DT&PL included the potential to detect hidden distress, allow opportunity for distress to be discussed, and to deliver outcomes to address problems. However, effectiveness and patient willingness to report all forms of distress could be hindered by: clinicians feeling ill-equipped to deal with 'non-physical' distress and patients questioning their appropriateness to do so; time constraints; insufficient support services and referral guidelines; inappropriate timing; and lack of follow-up.
  
  
  CONCLUSIONS
  The benefits of a holistic needs assessment cannot be realised without matching time and frequency of administration to the dynamic nature of distress during cancer, and making changes to the context of delivery - for instance, providing protected time, increasing referral options and clinician training. Significant investment is needed to optimise potential benefits for patients.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom. Electronic address: Lucy.Biddle@bristol.ac.uk.
authors.forename: Lucy
authors.initials: L
authors.lastname: Biddle
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom.
authors.forename: Sangeetha
authors.initials: S
authors.lastname: Paramasivan
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Harris
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom.
authors.forename: Rona
authors.initials: R
authors.lastname: Campbell
authors.affiliation: Department of Clinical Psychology, Bristol Haematology and Oncology Centre, Horfield Road, Bristol, BS2 8ED, United Kingdom; School of Clinical Sciences, University of Bristol, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Brennan
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Hollingworth
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006694:Holistic Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D036301:Qualitative Research; D011788:Quality of Life; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology*; D013821:Thermometers
keywords: Cancer treatment; Distress screening and management; Distress thermometer and problem list; Oncology; Patient experiences; Qualitative