title: Use of the Distress Thermometer in a cancer helpline context: Can it detect changes in distress, is it acceptable to nurses and callers, and do high scores lead to internal referrals?
abstract: OBJECTIVE
  To improve understanding about; (1) the validity of the Distress Thermometer (DT) as a measure of changes in distress after a cancer helpline call, (2) the impact of a helpline call on callers' distress, (3) caller and helpline nurses' comfort with use of the DT, and (4) the extent to which DT scores over the critical threshold, are associated with referral to internal support services for follow-up psychosocial care.
  
  
  METHODS
  Callers (people diagnosed with cancer and their family/friends: N = 100) completed a questionnaire that included DT ratings (three time-points), the Depression Anxiety and Stress Scale-21 (DASS-21) and measures of comfort with the DT tool. Nurses recorded referrals to internal services and their comfort in using the DT in each call.
  
  
  RESULTS
  The DT correlated with the DASS-21 depression (r = 0.45, p < 0.001), anxiety (r = 0.56, p < 0.001) and stress (r = 0.64, p < 0.001) subscales demonstrating validity. Callers' self-rated distress was significantly lower after the call, regardless of gender or caller type (F(2, 97) = 63.67, p < 0.01, partial eta squared = 0.57). Over 74% of people diagnosed with cancer, 80% family/friends and 89.3% of nurses felt comfortable with DT use. Only 16% of participants were referred on to follow-up internal support services despite 90% of people with cancer and 75% of family/friends' DT scores' suggesting they required follow-up care.
  
  
  CONCLUSIONS
  The DT is a valid and acceptable tool for use by cancer helplines. Improved documentation of referrals is required to better understand referral patterns.
authors.affiliation: School of Psychology, Hughes Building, North Terrace, The University of Adelaide, Adelaide, South Australia 5005, Australia. Electronic address: karen.linehan@sa.gov.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Linehan
authors.affiliation: Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia 5063, Australia; Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Sturt Road, Bedford Park, South Australia 5042, Australia; Sansom Institute for Health Research, Level 5, Playford Building, City East Campus, University of South Australia, Adelaide, South Australia 5000, Australia. Electronic address: kate.fennell@unisa.edu.au.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Fennell
authors.affiliation: Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia 5063, Australia; Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Sturt Road, Bedford Park, South Australia 5042, Australia. Electronic address: donna.hughes@flinders.edu.au.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Hughes
authors.affiliation: Cancer Council SA, 202 Greenhill Road, Eastwood, South Australia 5063, Australia; Flinders Centre for Innovation in Cancer, School of Medicine, Flinders University of South Australia, Sturt Road, Bedford Park, South Australia 5042, Australia. Electronic address: carlene.wilson@flinders.edu.au.
authors.forename: Carlene J
authors.initials: CJ
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D017028:Caregivers / Q000523:psychology; D002648:Child; D005190:Family / Q000523:psychology; D005260:Female; D000066505:Help-Seeking Behavior; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010361:Patients / Q000523:psychology; D012017:Referral and Consultation; D013315:Stress, Psychological / Q000145:classification* / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cancer; Distress; Helpline; Nurse; Oncology; Patient information; Psycho-social support; Screening; Telephone