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NCCN Guidelines for Patients



Distress, Version 1.2017


How distressed are you?

Screening tools


Screening benefits

Assessing distress is a key part of cancer

care. Part 2 is a review of the screening

process for distress. Screening tools are

described and the benefits of screening

are explained. You can also learn who can

help you with reducing distress.

Screening tools

A screening tool is a short assessment for a

condition. For distress, screening tools prompt you

to respond to one or more verbal statements or

questions. Distress screening tools have been tested

in research studies. They have been found to work

well for detecting who is distressed and pinpointing

people’s psychosocial needs.

There is more than one screening tool for distress.

Screening tools are often paper-based surveys.

However, hand-held devices, interactive voice

responses, and internet-based programs have also

been used. The screening tools created by NCCN

experts in distress are described next.

The Distress Thermometer and Problem List

The Distress Thermometer is a well-known screening

tool among cancer care providers. It has been shown

in many studies to work well. It measures distress on

a 0 to 10 scale.

See page 16.

To report your distress,

circle the number that matches your level of distress

in the past week.

The Problem List is completed along with the

Distress Thermometer. It will help your cancer care

team learn what is causing your distress. In turn,

your team can ask better follow-up questions and

refer you to the right help if needed.

You may receive a screening tool for distress at your

next doctor’s visit. You may complete the screen

while in the waiting room. If you are not screened for

distress, share this book and your scores with your

cancer care team.

Your cancer care team will discuss your scores

with you. Some types of distress may be managed

by your cancer care team. Other types may be

better addressed by people with a different set of

knowledge and skills. The experts in distress are

described later in this chapter.

Screening benefits

Distress screening is usually a quick process. If

paired with getting help as needed, it can yield major

benefits. Some of the benefits of distress screening

are listed next.

Detects who is distressed

. Without standard

screening, less than half of distressed people are

identified and get the help they need. Often, doctors

don’t ask and patients don’t tell their doctors about

their distress. Screening tools empower doctors to

inquire about distress and empower patients to share

how they are feeling. Read Part 4 to learn about

distress screening becoming a standard of care for

people with cancer.

Detailed evaluations

. You may receive an in-depth

assessment depending on what is bothering you. An

example is memory testing if you say your memory

is a big problem. Another example is a clinical

assessment for high distress about sexual problems

or pain. A clinical assessment may consist of one or

more of the following: an interview, survey, or health


Better distress management

. Early distress

screening leads to timely management of distress.

A study of routine screening showed that distressed

people referred to help as needed were less