Table 3. Examples of clinical guidance.

Example 1: Socially distressed: limited action indicated

A 55-year-old woman diagnosed with breast cancer 8 years ago. She had surgery followed by eight cycles of chemotherapy and was awaiting radiotherapy.

SD score=15. Individual SD items rated at 2 or 3: independence (rated 3), domestic chores (rated 2), mobility (rated 2), recreation (rated 3). Non-SD item: holidays (rated 3).

Guidance: ask in general how she is managing. Refer to the holiday item to check out if she wishes to discuss this. Unless she mentions any other specific concerns that in your clinical judgement you believe warrant more attention, take the issues no further as items on independence, domestic chores, mobility and recreation are likely to improve now the chemotherapy is over.

At the interview, she described feeling generally debilitated by the chemotherapy but was gradually improving. The couple usually shared household tasks, but now her husband was doing much more and was happy to do so. No information, advice or referral was made. Holiday issues included a conflict between the couple about a UK or foreign destination and lack of availability of holiday insurance. Information was given on insurance companies sympathetic to cancer patients and the suggestion made to discuss going on holiday with clinic staff in terms of fitness to travel.

Example 2: Socially distressed: action indicated

This man in his mid forties with acute myeloid leukaemia was diagnosed 2 years ago. He had progressive disease despite treatment with interferon, bone marrow transplant and Glivec and also was experiencing graft vs host disease.

SD score=24. Individual SD items rated at 2 or 3: domestic chores (rated 2), work (rated 2), planning the future (rated 3), body image (rated 2), isolation (rated 3), recreation (rated 2). Non-SD item: holidays (rated 2).

Guidance: this is a young man with high scores ranging over a number of varied items. Mention to him that it looks like he is having quite a difficult time at present with reference to the higher scoring items. Ask what support he has and, dependent upon his response, ask him if he wishes to discuss any of these issues with the clinic staff.

At the interview, he described feeling very isolated as his partner was out all day working, his mother, who had been a huge support, having died a year ago and due to being generally weakened from his disease and treatment and having no car being confined to the house for long periods. This had left him feeling depressed, tearful and lacking hope. He was referred to clinical psychology for assessment and support.

Example 3: Not socially distressed: no action indicated

A 45-year-old woman with metastatic oesophageal cancer diagnosed 2 months ago. She started combination chemo/radiotherapy treatment and had a Hickman line.

SD score=8. Individual SD items rated at 2 or 3: recreation (rated 2).

Guidance: make a general comment on how well she appears to be doing with reference to the SDI. Unless she raises any specific issues, no other action is indicated.

At the interview, the patient stated that although feeling a little nauseated and tired she was managing well with wonderful support from family and friends. Her main concern was not being able to play tennis due to the Hickman line and treatment. No information, advice or referral was given.

Example 4: Not socially distressed: action indicated

A 62-year-old man who had completed his combination chemo/radiotherapy treatment and surgery for primary local cancer of the rectum. Attended review clinic with his wife.

SD score=9. Individual SD items: welfare benefits (rated 3), finances (rated 2), work (rated 2). Non-SD item: sexual matters (rated 3).

Guidance: this is a man with very specific high scores concerning money and work, in addition to the item on sexual matters. Ask specifically about the employment/money and sexual concerns, what support he has and, dependent upon his response, ask him if he wishes to discuss any of these issues with the clinic staff.

At the interview, the patient stated that he was employed but had not worked for over 6 months. His employer was ‘encouraging’ him to leave and was not sympathetic to his plight. He was receiving half his usual wage, was incurring additional expense due to his illness and was finding it hard to manage financially. Referral to social work was arranged. His sexual problems included impotence, not resolved by use of Viagra. He felt at this time that he would put up with the problem rather than pursue more help and incur more cost.