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Cited by 130Cancer survivorship and careMental Health Treatment and AccessPatient-Provider Communication in Healthcare

Desire for psychological support in cancer patients with depression or distress: Validation of a simple help question

Open access
Baker‐Glenn, Elena A., Park, Bert, Granger, Lorraine, Symonds, Paul, Mitchell, Alex J.·2011·Psycho-Oncology
DOI 10.1002/pon.1759
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Abstract

Objectives: Despite documented high rates of psychological distress, it is not clear how to identify those who are willing to accept help. The aim of this study was to investigate whether asking patients receiving chemotherapy if they want help with emotional problems is valuable and to investigate the type of help they want. Methods: Patients attending a chemotherapy suite were asked to complete the Hospital Anxiety and Depression Scale, the Brief Patient Health Questionnaire (PHQ) and the Emotion Thermometers tools. Results were compared with a single question on desire for help. Results: In this study, 128 patients completed questionnaires for distress, depression, anxiety and desire for help at initial interview. Only one in five unselected patients had a perceived need for help, and in distressed patients only 36% expressed a desire for help. The addition of the help question to the two questions (PHQ-2) about mood and interest improved the ability to rule-in depression by increasing the specificity. However, by addition of this question, sensitivity was significantly reduced. Desire for help was modestly associated with severity of distress, anxiety and depression. Conclusions: The addition of a help question appears to have limited value in screening for psychological symptoms, but it may highlight those who are willing to accept addition support. Clinicians should attempt to offer a range of psychosocial interventions that will be acceptable to patients with distress. Copyright © 2010 John Wiley & Sons, Ltd.

AI snapshot

Written from the paper’s full text.

TL;DR

Among cancer patients starting chemotherapy, only a minority wanted psychological help, including roughly one-third of those with distress. A single help question was limited as a stand-alone screen and, when added to the PHQ-2, improved specificity but reduced sensitivity, though it may still identify patients willing to accept support.

Key findings

  • Of 130 patients, 26 (20%) asked for help; among those distressed on the Distress Thermometer, 36.7% wanted help. Mean Help Thermometer ratings were 4.4 for those wanting help versus 1.3 for those not wanting help.
  • The help question alone had moderate positive predictive value for anxiety (0.808) and negative predictive value for depression (0.806 or higher), but low sensitivity. Adding it to the PHQ-2 raised specificity and lowered sensitivity, with no overall accuracy gain for PHQ-9 depression or HADS-T distress.
  • The most requested support was face-to-face contact (61.5%), followed by complementary therapy (57.7%); medication was least requested (19.2%). Preferred sources included nurse specialists (53.8%) and family/friends (46.2%).
  • Path analysis linked desire for help to distress (standardized mean weight 0.271), anxiety (0.225), and depression (0.122), but these variables together explained only 42% of the variance.

Methods

  • Patients with cancer attending their first chemotherapy at Leicester Royal Infirmary between March and August 2007 were approached; 173 were approached, 130 participated, and 128 completed all initial questionnaires. Exclusions included inability to consent, not speaking English, or being too unwell.
  • Measures included the Hospital Anxiety and Depression Scale, PHQ-9/PHQ-2, Emotion Thermometers including the Help Thermometer, and a single yes/no question about wanting help for emotional or psychological concerns, with follow-up questions on preferred help type and source.
  • Analyses used Pearson’s chi-square with Yates’ correction, diagnostic accuracy statistics (sensitivity, specificity, PPV, NPV, fraction correct), ROC curve analysis for the Help Thermometer, and path analysis; software included R 2.7.0, AMOS 5, and Excel 2007.

Limitations

  • The paper states the sample was small and heterogeneous in disease stage and diagnosis, preventing analyses by gender, diagnosis, age, or ethnicity; few patients wanted help. It also notes that HADS and PHQ-9 were used as gold standards rather than structured interviews, that HADS cut-offs remain debated, and that symptom recall periods differed across tools.
  • The paper further states the study focused only on patients beginning chemotherapy, so preferences at other treatment points may differ.
  • Evident from the text: the single-centre chemotherapy setting, English-language requirement, and exclusion of patients too unwell to participate limit generalizability; the initial cross-sectional assessment cannot capture changing support preferences over time.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/pon.1759

Cites

26 of 27 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 1 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Among patients thought to be distressed on the DT, 36.7% wanted help.

    “Of those thought to be distressed on the DT, 36.7% wanted help.”
    • Also stated in: § Abstract · plain
      “in distressed patients only 36% expressed a desire for help”
    • Also stated in: § Discussion · plain
      “only 36% of distressed patients are willing to accept help for emotional or psychological difficulties”
    Quote in the paperSubstantial claim
  • Findingown data

    The help question used alone could not be used as a case-finding method for distress or depression.

    “The data show that the help question used alone was moderately successful at confirming the presence of anxiety (PPV 5 0.808) but could not be used as a case-finding method for distress or depression.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Rule-out accuracy for anxiety was the least successful.

    “Rule-out accuracy for anxiety was the least successful.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In this sample of cancer patients attending first chemotherapy, 26 of 130 (20%) indicated they would like help on the single-item help questionnaire.

    “Twenty-six of the 130 patients (20%) indicated that they would like help on the single-item help questionnaire.”
    • Also stated in: § Abstract · plain
      “Only one in five unselected patients had a perceived need for help”
    • Also stated in: § Discussion · plain
      “We found that only 20% of unselected patients and only 36% of distressed patients are willing to accept help for emotional or psychological difficulties.”
    Quote in the paperSubstantial claim
  • Findingown data

    The preferred sources of help were nurse specialists (53.8%), family and friends (46.2%), hospital doctors (26.9%), GP (23.1%), psychologist (19.2%), spiritual advisor (7.7%) and a psychiatrist (3.8%).

    “The preferred sources of help were: nurse specialists (53.8%), family and friends (46.2%), hospital doctors (26.9%),GP (23.1%), psychologist (19.2%), spiritual advisor (7.7%) and a psychiatrist (3.8%).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 10
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Findingown data

    Of those saying they did not want help, eleven (10.6%) scored 4 or above on four symptom-related ETs, twenty-three (22.1%) scored 15 or above on HADS-T and 20 (19.2%) scored 10 or above on the PHQ-9.

    “Of those saying that they did not want help, eleven (10.6%) scored 4 or above on foursymptom-related ETs.Twenty-three patients (22.1%) scored 15 or above on HADS-T and 20 (19.2%) scored 10 or above on the PHQ-9.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In this sample, 62 (48.1%) patients were anxious according to HADS-A, 24 (18.6%) were depressed on HADS-D, 37 (28.7%) were distressed using HADS-T, 29 (22.5%) rated as depressed on PHQ-9 and 27 (20.9%) scored positively on PHQ-2.

    “In this sample, 62 (48.1%) patients were anxious according to HADS-A, 24 (18.6%) were depressed on HADS-D, 37 (28.7%) were distressed using HADS-T, 29 (22.5%)rated as depressed on PHQ-9 and 27 (20.9%)scored positively on PHQ-2.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Of those who indicated that they wanted help, nine (34.6%) scored 4 or above on all four-symptom-related ETs, fourteen (53.8%) scored 15 or above on HADS-T, and nine (34.6%) scored 10 or above on the PHQ-9.

    “Of those who indicated that they wanted help, nine (34.6%) scored 4 or above on all four-symptom-related ETs, fourteen (53.8%) scored 15 or above on HADS-T, and nine (34.6%) scored 10 or above on the PHQ-9.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At the HT threshold of 3 or above, the HT had a sensitivity of 1.00, specificity of 0.66, PPV of 0.43 and NPV of 1.00.

    “At this threshold, the HT had a sensitivity of 1.00 and a specificity of 0.66 and a PPV of 0.43 and a NPV of 1.00.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The addition of the help question to the PHQ-2 significantly lowered sensitivity with a minor gain in specificity and an overall reduction in accuracy.

    “we found a combination of the help question with the two items from the PHQ-2 significantly lowered the sensitivity with a minor gain in specificity and an overall reduction in accuracy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among those who wanted help, 57.7% requested complementary therapy, 42.3% wanted support for family and carers, 34.6% wanted information about their illness, 30.8% wanted self-help guides, 30.8% wanted support groups, and 19.2% wanted medication.

    “Looking at other types of help that people wanted revealed that 57.7% of patients requested complementary therapy, 42.3% wanted support for family and carers, 34.6% wanted information about their illness, 30.8% wanted self-help guides and 30.8% wanted support groups.The least popular option was medication (19.2%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The mean rating on the 'desire for help' thermometer was 4.4 for those who wanted help and 1.3 for those who did not want help.

    “The mean rating on the 'desire for help' thermometer was 4.4 for this group of patients.”
    • Also stated in: § Description of perceived desire for help · plain
      “The mean rating on the 'desire for help' thermometer for this group was 1.3.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One hundred and twenty-eight of the 130 patients completed all of the questionnaires at initial evaluation.

    “One hundred and twenty-eight of the 130 patients completed all of the questionnaires at initial evaluation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Potential diagnosis was made based on PHQ-9 and HADS scores, and there is ongoing debate about the optimal cut-off point on the HADS and whether the total score or subscales are more optimal.

    “Potential diagnosis was also made based on PHQ-9 and HADS scores; there is ongoing debate about the optimal cut-off point on the HADS and whether or not the total score should be used or whether the use of subscales is more optimal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Of 173 individuals approached, 130 (75.1%) were willing and able to participate in this study.

    “Of 173 individuals approached, 130 (75.1%) were willing and able to participate in this study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Patients were asked to rate symptoms over the last week or 2 weeks depending on the tool used.

    “A further limitation of the study is that patients were asked to rate symptoms over the last week or 2 weeks depending on the tool used.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The HADS and PHQ-9 were used as the gold standard in this study, potentially limiting the interpretation of results as a better gold standard would have been a structured interview.

    “The HADS and PHQ-9 were being used as the gold standard in this study, potentially limiting the interpretation of any results as a better gold standard would have been a structured interview.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Strengths of this study include that two measures were used as comparison tools and patients were all given the questionnaires at the same time points within their treatment.

    “Strengths of this study include the fact that two measures were used as comparison tools and patients were all given the questionnaires at the same time points within their treatment.”
    Quote in the paperNot a substantial claim
13 of 13

  • The paper relies on this without support.

    The single help question is a valid criterion measure of desire for help.

    “We examined the accuracy of the HT as a predictor of desire for help based on the single desire for help question.”

  • The paper relies on this without support.

    There is no consensus on how to measure desire for help in cancer settings.

    “but as yet there is no consensus on how to measure this domain in cancer settings.”

  • The paper relies on this without support.

    The HADS and PHQ-9 scores adequately identify depression or distress for use as the reference standard in this study.

    “The HADS and PHQ-9 were being used as the gold standard in this study, potentially limiting the interpretation of any results as a better gold standard would have been a structured interview.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Willingness to talk to a psychologist or social worker has previously been demonstrated to be associated with higher psychological distress.

    “The same holds for the association between willingness to talk to a psychologist or social worker, which has previously been demonstrated to be associated with higher psychological distress [16, 26].”

    From Adjustment disorder in cancer patients after treatment: prevalence and acceptance of psychological treatment (2022) · cites this paper as [26]

    The Discussion (page not provided) says that patients with greater distress were more likely to want help, supporting the general association. The ‘Description of perceived desire for help’ section lists psychologist as one possible source of help, but does not establish that distress was associated specifically with willingness to talk to a psychologist or social worker. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • The higher uptake rates in the present study compared with survey-reported interest of 14-41% may be inflated by an altruistic desire to participate in research.

    “Even this weighted uptake rate is higher than seen in surveys, which report that between 14 and 41% of cancer patients show a definite interest in psychological support [19,20,30] possibly suggesting that the higher uptake rates in the present study are inflated by an altruistic desire to participate in the research.”

    From Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. (2016) · cites this paper as [19]

  • Higher distress has predicted desire for help or uptake of interventions in some but not all reports.

    “Because higher distress has predicted desire for help or uptake of interventions in some [19,20,22,31] although not all [21,[32][33][34] reports, it was anticipated that those who were distressed may be more likely to uptake the offer of help.”

    From Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. (2016) · cites this paper as [19]

  • Survey studies suggest that desire for help is low.

    “Survey studies suggest that desire for help is low [19,20], but there is little research into whether or not patients accept interventions that are actually offered and if so, whether the course of treatment is completed.”

    From Psychological intervention targeting distress for cancer patients: a meta-analytic study investigating uptake and adherence. (2016) · cites this paper as [19]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Reported desire for help exceeds the study total

    Minor

    The paper says 73 patients who were not distressed perceived a desire for help, but says only 26 patients in the entire sample wanted help.

  • PHQ-9 specificity for the help question differs between tables

    Minor

    For the same help-question-alone comparison against PHQ-9 depression, Table 2 reports specificity of 0.630 while Table 1 reports 0.830. The other accuracy values in those rows agree.

  • Fraction correct at the lowest thermometer threshold is wrong

    Minor

    At this threshold, sensitivity is 1.00 and specificity is 0.00, so every patient is classified as wanting help. The fraction correct must therefore equal the 26 of 130 patients who wanted help, or 0.20, not 0.64.

    Reported 0.64 · recomputed 0.2

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. 10.1002/cncr.20992 · DOI · Paper page

Cited by

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Related

Authors
Baker‐Glenn, E. A., Park, B., Granger, L., Symonds, P., & Mitchell, A. J.
Affiliations
  • Nottinghamshire Healthcare NHS Foundation Trust (GB)
  • Leicester Royal Infirmary (GB)
ORCID
Venue
Psycho-Oncology
Publisher
Wiley
Published
2011-04
Volume
20
Issue
5
Pages
525-531
ISSN
  • 1057-9249 (ISSN-L)
  • 1099-1611
DOI
10.1002/pon.1759
OpenAlex
W1987178171
Cited by
130
References
26
Citations by year
2026: 1 · 2025: 7 · 2024: 4 · 2023: 10 · 2022: 7 · 2021: 4 · 2020: 11 · 2019: 11 · 2018: 11 · 2017: 12 · 2016: 13 · 2015: 6 · 2014: 9 · 2013: 6 · 2012: 9
FWCI
3.63
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Psycho-Oncology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
psychological distress, depression, anxiety, cancer patients, chemotherapy, help-seeking, screening, PHQ-2, Hospital Anxiety and Depression Scale, psychosocial interventions
MeSH terms
Depression, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, Neoplasms, Psychiatric Status Rating Scales, Psychological Tests, Psychotherapy, Surveys and Questionnaires, Stress, Psychological

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