All health professionals can work collaboratively with people affected by cancer to identify their existing resources and capacity for self-management and identify need for further assessment to guide information provision, supportive care interventions and referral to additional specialist services and resources.
Further assessment focussing on problems identified in screening, which have not been addressed with therapeutic communication, may be appropriate to clarify the extent and burden of problems.3 If required a range of evidence-based tools can be used by members of the multidisciplinary team to undertake this more focused assessment. Examples of tools to assess specific symptoms or concerns include:
- Brief Pain Inventory49
- Spirituality assessment – HOPE Questions50
- Bristol stool chart51
- Kessler Psychological Distress Scale (K10) 52
- Hospital and Anxiety Depression Scale53
- Common Terminology Criteria for Adverse Events (CTCAE)54 Grading scales for physical symptoms are identified and provide a framework for consistent assessment of need.
For example, the Kessler Psychological Distress Scale (K10)52 has been recommended by some to assist in decision making when referring patients who have a score ≥ 4 on the Distress Thermometer.20 The K10 is a measure developed to detect psychological distress. The K10 has been shown to be a valid measure of psychological distress when compared to other measures. A limitation of the tool is that it is not cancer specific. It is commonly used by General Practitioners referring patients for counselling or psychological services.55
Each question on the K10 has a five point response scale. The response options are scored from five (All of the time) to one (None of the time). The final score will be between 10 and 50. The final scores should be interpreted as follows:55
|A score of < 16:||Indicates people with no increased likelihood of anxiety of depressive disorder|
|A score of 16 – 30:||Indicates people with three times the population risk of having a current anxiety or depressive disorder|
|A score of 31 – 50:||Indicates people with ten times the population risk of having a current anxiety or depressive disorder.|
Jane identified three problems in the emotional domain. Whilst she feels less anxious after learning more about her treatment, she indicates that she would like some further help to manage her feelings. You identify a number of resources that Jane may wish to access:
- Cancer council helpline
- Hospital or community-based support programs, eg psycho-education programs, peer support programs
- Social worker
- General Practitioner.
Jane has a close relationship with her GP, and feels it would be good to follow up her concerns with someone familiar.
Jane’s GP gets her to complete the K10 checklist. Her results are below.
- What is Jane’s final score?
- What does this indicate?