The diagnosis and treatment of cancer is a major life stress such that approximately 35% of patients experience persistent clinically significant distress and carers also experience high distress. This paper applies experiences from a randomised controlled trial with high distress patient and carers comparing minimal contact self-management vs. an individualised tele-based cognitive behavioural intervention to inform service delivery. Methods/design: 354 cancer patients and 336 carers were identified as high distress through caller screening with the Distress Thermometer (>4) at two community-based cancer helplines. Callers were then randomised to 1) a single 30-minute telephone support and education session with a nurse counsellor with self-management materials or, 2) a tele-based psychologist delivered five session individualised cognitive behavioural intervention. Session components included stress reduction, problem-solving, cognitive challenging and enhancing relationship support. Participants were assessed at baseline and 3 months after recruitment. Outcome measures included the Brief Symptom Inventory-18. Use of support services was also assessed. Results: Although the mean time since diagnosis was 1.74 years, 53.4% of patients and 45.2% of carers reached caseness for distress. Only 21.5% of all participants had sought psychosocial services from a mental health professional in the past month prior to entering the trial; most often a social worker or psychologist. The source most often described as providing emotional support was family and friends (81.9%) followed by the doctor (22.4%) and nurse (14.2%). For all participants, post-intervention (3 months) study retention was significantly better for the brief nurse session compared to the five session psychologist intervention (89% vs. 79.8%: p = .0009); and poorer overall for carers compared to patients (79.6% vs. 89%; p = .0007). Discussion: Both intervention approaches were highly acceptable to distressed patients and carers, although the single session performed better in terms of retention at 3 month follow-up. Most of these high distress callers had not sought specialist mental health services; and relied for support on family and friends. Strategies such as distress screening are essential to improve translation of evidence-based interventions. Providing support to carers, increasing accessibility through telephone delivery, and flexibility in level of support are all important in translating and disseminating interventions and reducing barriers to utilising support for people with high distress.