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Translating Research on the Distress Thermometer Into Practice

Susan S. Tavernier
CJON 2014, 18(1), 26-30 DOI: 10.1188/14.CJON.S1.26-30

Distress is commonly experienced by people with cancer. The National Comprehensive Cancer Network (NCCN) developed a guideline for screening and managing distress in 1999 and has updated the guideline on an annual basis ever since. Using the five-phase framework for translational research, this article summarizes research findings related to the guideline and associated distress thermometer for each phase of translational research. The NCCN Distress Management Guideline is a useful tool to screen for and manage distress. However, additional research is needed, particularly in the areas of impact on outcomes of importance to patients.


Absolom, K., Holch, P., Pini, S., Hill, K., Liu, A., Sharpe, M., … Palliative Care Research. (2011). The detection and management of emotional distress in cancer patients: The views of health-care professionals. <i>Psycho-Oncology, 20</i>, 601-608.

American College of Surgeons. (2012). <i>Cancer program standards 2012: Ensuring patient-centered care. American College of Surgeons Commission on Cancer.</i> Retrieved from <a target="_blank" href='http://www.facs.org/cancer/coc/programstandards2012.pdf'>http://www.facs...

Bidstrup, P. E., Mertz, B. G., Dalton, S. O., Deltour, I., Kroman, N., Kehlet, H., … Johansen, C. (2012). Accuracy of the Danish version of the "distress thermometer." <i>Psycho-Oncology, 21</i>, 436-443. doi:10.1002/pon.1917

Bultz, B. D., & Carlson, L. E. (2005). Emotional distress: The sixth vital sign in cancer care. <i>Journal of Clinical Oncology, 23</i>, 6440-6441. doi:10.1200/jco.2005.02.3259

Carlson, L. E., Groff, S. L., Maciejewski, O., & Bultz, B. D. (2010). Screening for distress in lung and breast cancer outpatients: A randomized controlled trial. <i>Journal of Clinical Oncology, 28</i>, 4884-4891. doi:10.1200/jco.2009.27.3698

Carlson, L. E., Waller, A., Groff, S. L., & Bultz, B. D. (2013). Screening for distress, the sixth vital sign, in lung cancer patients: Effects on pain, fatigue, and common problems—Secondary outcomes of a randomized controlled trial. <i>Psycho-Oncology, 22</i>, 1880-1888. doi:10.1002/pon.3223

Carlson, L. E., Waller, A., Groff, S. L., Giese-Davis, J., & Bultz, B. D. (2013). What goes up does not always come down: Patterns of distress, physical and psychosocial morbidity in people with cancer over a one-year period. <i>Psycho-Oncology, 22</i>, 168-176. doi:10.1002/pon.2068

Carlson, L. E., Waller, A., & Mitchell, A. J. (2012). Screening for distress and unmet needs in patients with cancer: Review and recommendations. <i>Journal of Clinical Oncology, 30</i>, 1160-1177.

Clark, P. G., Bolte, S., Buzaglo, J., Golant, M., Daratsos, L., & Loscalzo, M. (2012). From distress guidelines to developing models of psychosocial care: Current best practices. <i>Journal of Psychosocial Oncology, 30</i>, 694-714. doi:10.1080/07347332.2012.721488

Cochrane, L. J., Olson, C. A., Murray, S., Dupuis, M., Tooman, T., & Hayes, S. (2007). Gaps between knowing and doing: Understanding and assessing the barriers to optimal health care. <i>Journal of Continuing Education in Healthcare Professions, 27</i>, 94-102. doi:10.1002/chp.106

Cohen, M. (2013). The association of cancer patients' emotional suppression and their self-rating of psychological distress on short screening tools. <i>Behavioral Medicine, 39</i>, 29-35. doi:10.1080/08964289.2012.731440

Dudgeon, D., King, S., Howell, D., Green, E., Gilbert, J., Hughes, E., … Sawka, C. (2012). Cancer Care Ontario's experience with implementation of routine physical and psychological symptom distress screening. <i>Psycho-Oncology, 21</i>, 357-364.

Edwards, A., Pang, N., Shiu, V., & Chan, C. (2010). The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: A meta-study of qualitative research. <i>Palliative Medicine, 24</i>, 753-770. doi:10.1177/0269216310375860

Faller, H., Schuler, M., Richard, M., Heckl, U., Weis, J., & Küffner, R. (2013). Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: Systematic review and meta-analysis. <i>Journal of Clinical Oncology, 31</i>, 782-793. doi:10.1200/jco.2011.40.8922

Fitch, M. I. (2011). Screening for distress: A role for oncology nursing. <i>Current Opinion in Oncology, 23</i>, 331-337.

Franchi, G., Bulli, F., Muraca, M. G., Maruelli, A., Grechi, E., & Miccinesi, G. (2013). Impact of a psycho-oncological rehabilitation intervention on psychological distress: The experience of CeRiOn (Oncological Rehabilitation Centre) Florence 2007-2010. <i>Supportive Care in Cancer</i>, 21, 2381-2386. doi:10.1007/s00520-013-1803-x

Grassi, L., Rossi, E., Caruso, R., Nanni, M. G., Pedrazzi, S., Sofritti, S., & Sabato, S. (2011). Educational intervention in cancer outpatient clinics on routine screening for emotional distress: An observational study. <i>Psycho-Oncology, 20</i>, 669-674.

Hammonds, L. S. (2012). Implementing a distress screening instrument in a university breast cancer clinic. <i>Clinical Journal of Oncology Nursing, 16</i>, 491-494.

Holland, J. C., & Bultz, B. D. (2007). The NCCN guideline for distress management: A case for making distress the sixth vital sign. <i>Journal of the National Comprehensive Cancer Network, 5</i>, 3-7.

Hughes, K. L., Sargeant, H., & Hawkes, A. L. (2011). Acceptability of the distress thermometer and problem list to community-based telephone cancer helpline operators, and to cancer patients and carers. <i>BMC Cancer, 11</i>, 46. doi:10.1186/1471-2407-11-46

Jacobsen, P. B., & Ransom, S. (2007). Implementation of NCCN distress management guidelines by member institutions. <i>Journal of the National Comprehensive Cancer Network, 5</i>, 99-103.

Kayser, K., Acquati, C., & Tran, T. V. (2012). No patients left behind: A systematic review of the cultural equivalence of distress screening instruments. <i>Journal of Psychosocial Oncology, 30</i>, 679-693. doi:10.1080/07347332.2012.721489

Kendall, J., Glaze, K., Oakland, S., Hansen, J., & Parry, C. (2011). What do 1,281 distress screeners tell us about cancer patients in a community cancer center? <i>Psycho-Oncology, 20</i>, 594-600. doi:10.1002/pon.1907

Khoury, M. J., Gwinn, M., Yoon, P. W., Dowling, N., Moore, C. A., & Bradley, L. (2007). The continuum of translation research in genomic medicine: How can we accelerate the appropriate integration of human genome discoveries into health care and disease prevention? <i>Genetic Medicine, 9</i>, 665-674. doi:10.1097GIM.0b013e31815699d0

Mitchell, A. J. (2010). Short screening tools for cancer-related distress: A review and diagnostic validity meta-analysis. <i>Journal of the National Comprehensive Cancer Network, 8</i>, 487-494.

Mitchell, A. J., Hussain, N., Grainger, L., & Symonds, P. (2011). Identification of patient-reported distress by clinical nurse specialists in routine oncology practice: A multicentre UK study. <i>Psycho-Oncology, 20</i>, 1076-1083. doi:10.1002/pon.1815

Mitchell, A. J., Vahabzadeh, A., & Magruder, K. (2011). Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary-care research. <i>Psycho-Oncology, 20</i>, 572-584. doi:10.1002/pon.1943

National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines in Oncology for Distress Management [V.2.2013]. Retrieved from <a target="_blank" href='http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#support...

Oktay, J. S., Nedjat-Haiem, F. R., Davis, C., & Kern, K. C. (2012). Distress screening: Experiences of oncology social workers. <i>Journal of Psychosocial Oncology, 30</i>, 652-666. doi:10.1080/07347332.2012.721490

Oncology Nursing Society. (2013). Implementing screening for distress: The joint position statement from the American Psychosocial Oncology Society, Association of Oncology Social Work, and Oncology Nursing Society. <i>Oncology Nursing Forum, 40</i>, 423-424.

Patel, S. K., Mullins, W., Turk, A., Dekel, N., Kinjo, C., & Sato, J. K. (2011). Distress screening, rater agreement, and services in pediatric oncology. <i>Psycho-Oncology, 20</i>, 1324-1333.

Pirl, W. F., Muriel, A., Hwang, V., Kornblith, A., Greer, J., Donelan, K., … Schapira, L. (2007). Screening for psychosocial distress: A national survey of oncologists. <i>Journal of Supportive Oncology, 5</i>, 499-504.

Roerink, S. H., de Ridder, M., Prins, J., Huijbers, A., de Wilt, H. J., Marres, H., … Netea-Maier, R. T. (2013). High level of distress in long-term survivors of thyroid carcinoma: Results of rapid screening using the distress thermometer. <i>Acta Oncologica, 52</i>, 128-137. doi:10.3109/0284186x.2012.723822

Ryan, D. A., Gallagher, P., Wright, S., & Cassidy, E. M. (2012). Sensitivity and specificity of the distress thermometer and a two-item depression screen (Patient Health Questionnaire-2) with a "help" question for psychological distress and psychiatric morbidity in patients with advanced cancer. <i>Psycho-Oncology, 21</i>, 1275-1284.

Scott, K., & McSherry, R. (2009). Evidence-based nursing: Clarifying the concepts for nurses in practice. <i>Journal of Clinical Nursing, 18</i>, 1085-1095. doi:10.1111/j.1365-2702.2008.02588.x

Tavernier, S. S., Beck, S. L., & Dudley, W. N. (2013). Diffusion of a distress management guideline into practice. <i>Psycho-Oncology.</i> Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/pon.3295/abstract;jsessionid=... <a target="_blank" href='http://onlinelibrary.wiley.com/doi/10.1002/pon.3295/abstract;jsessionid=...

Thewes, B., Butow, P., & Stuart-Harris, R. (2009). Does routine psychological screening of newly diagnosed rural cancer patients lead to better patient outcomes? Results of a pilot study. <i>Australian Journal of Rural Health, 17</i>, 298-304.

Titler, M. G. (2011). Nursing science and evidence-based practice. <i>Western Journal of Nursing Research, 33</i>, 291-295.

van't Spijker, A., Trijsburg, R. W., & Duivenvoorden, H. J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. <i>Psychosomatic Medicine, 59</i>, 280-293.

Vitek, L., Rosenzweig, M. Q., & Stollings, S. (2007). Distress in patients with cancer: Definition, assessment, and suggested interventions. <i>Clinical Journal of Oncology Nursing, 11</i>, 413-418.

Vodermaier, A., Linden, W., & Siu, C. (2009). Screening for emotional distress in cancer patients: A systematic review of assessment instruments. <i>Journal of the National Cancer Institute, 101</i>, 1464-1488. doi:10.1093/jnci/djp336

Waller, A., Williams, A., Groff, S. L., Bultz, B. D., & Carlson, L. E. (2013). Screening for distress, the sixth vital sign: Examining self-referral in people with cancer over a one-year period. <i>Psycho-Oncology, 22</i>, 388-395. doi:10.1002/pon.2102

Yamaguchi, T., Morita, T., Sakuma, Y., Kato, A., Kunimoto, Y., & Shima, Y. (2012). Longitudinal follow-up study using the distress and impact thermometer in an outpatient chemotherapy setting. <i>Journal of Pain and Symptom Management, 43</i>, 236-243.

Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. <i>Psycho-Oncology, 10</i>, 19-28. doi:10.1002/1099-1611(200101/02)10:1<19::aid-pon501>3.0.co;2-6

Ziegler, L., Hill, K., Neilly, L., Bennett, M. I., Higginson, I. J., Murray, S. A., & Stark, D. (2011). Identifying psychological distress at key stages of the cancer illness trajectory: A systematic review of validated self-report measures. <i>Journal of Pain and Symptom Management, 41</i>, 619-636.

Zwahlen, D., Hagenbuch, N., Jenewein, J., Carley, M. I., & Buchi, S. (2011). Adopting a family approach to theory and practice: Measuring distress in cancer patient-partner dyads with the distress thermometer. <i>Psycho-Oncology, 20</i>, 394-403.