Aims To provide the basis for the development of active components of complex interventions for distress and rigorous evaluation of process measures and patient outcomes. A staged co-ordinated approach was adopted, with collaborative members completing different components of the work.

Methods To supplement COMPASS trials evaluating screening for distress and testing complex interventions for depression in cancer patients, preparatory work for an intervention for distress was undertaken. Systematic meta-review of the use and meaning of the terms ‘psychological distress’ and ‘psychological interventions’ were completed. A prospective study of the outcomes of moderate distress over time (n=326) and a qualitative study of patient's views on potential treatments for moderate psychological distress (n=25) was undertaken in Edinburgh. The views of hospital-based oncology professionals about the assessment and management of psychological distress were explored in an interview study across the Yorkshire Cancer Network.

Results Moderate distress is common in cancer patients and persistent in a substantial minority at 7 months (36%). Distressed patients prefer information and guidance provided by those who understand the effect of cancer but are reluctant to see mental health professionals. 23 cancer professionals were interviewed (8 oncologists, 4 surgeons, 6 clinical nurse specialists (CNS) and 5 nurses). The CNS was pivotal to the detection and management of distress and overall, effective management was not optimal due to a lack of referral guidance and limited access to specialist psychological care. These studies supplement ongoing work evaluating screening for distress and depression and the evaluation of intensive treatments for depression in cancer patients.

Future research Future research generated from the COMPASS collaboration includes development of a training programme to enable clinicians to use output from screening measures and self-help interventions for psychological distress incorporating e-health technology.