Supportive Care in Cancer

, 17:1425 | Cite as

Routine assessment of social difficulties in cancer patients: are we opening Pandora’s box?

  • Emma J. Podmore
  • Laura C. Bingham
  • Kathryn M. Roberts
  • Peter J. Selby
  • Penny Wright
  • Galina Velikova
Short Communication


Goals of work

Living with cancer impacts on the social aspects of the lives of the patient and their families, causing problems that can remain undetected. The Social Difficulties Inventory (SDI) has been shown as an effective screening tool, but concerns exist that detecting more problems may increase the workload for clinic staff and related services. The aim of this analysis is to assess the level of unmet need for social difficulties and to identify any potential increase in required interventions that may occur as a result of detailed assessment.

Patients and methods

A previous cross-sectional interview study was conducted to establish the clinical utility of the SDI. Adult patients were recruited from oncology, haematology and chest medicine clinics. They completed the SDI and a semi-structured interview by a social worker, who was blind to the SDI results. With participant agreement, interventions were made for the detected problems. This paper reports on a secondary descriptive analysis of intervention data, which was performed to examine the details of the interventions and referral patterns.

Main results

No intervention was necessary for 108 (59%) of patients, 42 (23%) received information, 33 (15%) were referred to another service and five (3%) received both information and a referral. Most information was provided about holiday insurance. The majority of referrals were made to Social Work (55% of all referrals) with the main reason being related to benefits or finances.


Increased referral rate was observed following a social work interview, when comparing with local audit data. However, the majority of needs could be met by increasing accessibility of information.


Cancer Social difficulties Patient-centred assessment Psychosocial Referral rates 



We acknowledge the contribution of patients who participated in the study. This work was funded by the Cancer Research UK and the Yorkshire Cancer Research Network.




  1. 1.
    Cull A, Stewart M, Altman DG (1995) Assessment of and intervention for psychosocial problems in routine oncology practice. Br J Cancer 72:229–235PubMedGoogle Scholar
  2. 2.
    Eakin EG, Strycker LA (2001) Awareness and barriers to use of cancer support and information resources by HMO patients with breast, prostate, or colon cancer: patient and provider perspectives. Psychooncology 10:103–113CrossRefPubMedGoogle Scholar
  3. 3.
    Department of Health (ed) (2007) Cancer reform strategy. Central Office of Information, London. pp 9–10, 22, 70–84Google Scholar
  4. 4.
    Macmillan Cancer Support, University of Southampton (2006) We listen to patients: a Macmillan Cancer Support report - the research priorities of people affected by cancer. University of Southampton, SouthamptonGoogle Scholar
  5. 5.
    National Institute for Health and Clinical Excellence (ed) (2004) Guidance on cancer services—improving supportive and palliative care for adults with cancer—the manual. National Institute for Health and Clinical Excellence, London. pp 86–94Google Scholar
  6. 6.
    Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM (1996) Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet 347:724–728CrossRefPubMedGoogle Scholar
  7. 7.
    Taylor C, Graham J, Potts HW, Richards MA, Ramirez AJ (2005) Changes in mental health of UK hospital consultants since the mid-1990s. Lancet 366:742–744CrossRefPubMedGoogle Scholar
  8. 8.
    Thorne SE, Bultz BD, Baile WF (2005) Is there a cost to poor communication in cancer care?: a critical review of the literature. Psychooncology 14:875–884 discussion 885-876CrossRefPubMedGoogle Scholar
  9. 9.
    Travado L, Grassi L, Gil F, Ventura C, Martins C (2005) Physician-patient communication among Southern European cancer physicians: the influence of psychosocial orientation and burnout. Psychooncology 14:661–670CrossRefPubMedGoogle Scholar
  10. 10.
    Wright EP, Kiely M, Johnston C, Smith AB, Cull A, Selby PJ (2005) Development and evaluation of an instrument to assess social difficulties in routine oncology practice. Qual Life Res 14:373–386CrossRefPubMedGoogle Scholar
  11. 11.
    Wright EP, Kiely MA, Lynch P, Cull A, Selby PJ (2002) Social problems in oncology. Br J Cancer 87:1099–1104CrossRefPubMedGoogle Scholar
  12. 12.
    Wright P, Marshall L, Smith AB, Velikova G, Selby P (2008) Measurement and interpretation of social distress using the social difficulties inventory (SDI). Eur J Cancer 44:1529–1535CrossRefPubMedGoogle Scholar
  13. 13.
    Wright P, Smith A, Booth L, Winterbottom A, Kiely M, Velikova G, Selby P (2005) Psychosocial difficulties, deprivation and cancer: three questionnaire studies involving 609 cancer patients. Br J Cancer 93:622–626CrossRefPubMedGoogle Scholar
  14. 14.
    Wright P, Smith A, Roberts K, Selby P, Velikova G (2007) Screening for social difficulties in cancer patients: clinical utility of the Social Difficulties Inventory. Br J Cancer 97:1063–1070CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Emma J. Podmore
    • 1
  • Laura C. Bingham
    • 1
  • Kathryn M. Roberts
    • 2
  • Peter J. Selby
    • 1
  • Penny Wright
    • 1
  • Galina Velikova
    • 1
  1. 1.Psychosocial and Clinical Practice Research Group, Cancer Research UKSt James’s Institute of OncologyLeedsUK
  2. 2.Leeds City Council Social Services Department, Rehabilitation UnitSt James’s Institute of OncologyLeedsUK

Personalised recommendations