Background: Distress screening, utilising the NCCN’s Distress Thermometer, is increasing in practice environments. This simple to administer tool is attractive to busy clinicians and has demonstrated acceptability to patients.  In clinical practice a cut off score of 4 is identified as the threshold for further clinical assessment and potential intervention. However practice varies as to interpretation of the meaning of the score and which professionals manage the process of interpretation, intervention and referral.  Distress, according to the NCCN, is an “unpleasant emotional experience of a psychological (cognitive, behavioural or emotional), social or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatments” (NCCN Version 3.2012). However, regarding distress as largely an emotional experience may fail to focus the practitioner on the factors leading to distress, particularly when a distress score of 4 or greater leads to a referral to a psychosocial health professional without further exploration of the causative factors. While the problem check list provided by the NCCN and the referral flow charts provide strong recognition of the role of physical symptoms in understanding distress, recent experiences in Victoria suggest that local sites frequently modify the check list and may place less emphasis on causative factors and link higher scores to automatic involvement of a psychosocial health professional.

Methods: We examined the relationship between distress scores, HADs scores and other factors reported by men with prostate cancer about to start curative intent radiotherapy. Overall distress scores in this population were low with a mean score of 1.96 (SD = 2.22) and with 19.7% of men scoring 4 or more. 32% of men reporting 4 or more on DT also recorded HADs scores indicative of anxious symptomatology. Only 9.2% of men with a DT score of 4 or more reported HADs scores indicative of depression. 1 person with a HADs score indicative of anxiety and 2 with scores indicative of depression had a DT score less than 4, indicating a small group that may be missed by this screening method.  A hierarchical multiple regression analysis was undertaken to examine the predictors of distress in this population.  Significant predictors covered a range of domains including hormonal summary scores, anxiety and depression, and unmet daily living and physical needs.

Conclusion: Nurses can be confident that DT assists in the identification of most  patients with anxious and depressive symptomatology requiring referral for additional assessment and intervention. More work needs to be done to explore the identification of the minority who were potentially depressed or anxious who did not score 4 or more on the DT. However, DT scores are also predicted by factors associated with cancer and its treatment that might best be addressed by the doctor or nurse in the clinic. In other work by our group the largest predictor of psychological distress was physical symptom burden, consistent with some of the findings of this  analysis. This suggests that the problem check list might need to be tailored to specific patient groups or used in conjunction with a symptom check list in order to accurately respond to those factors contributing to distress.