Table 3.

Examples of strategies to address patient distress

Type of Distress	Specific techniques to address Distress
Practical - finances; difficulty with domestic tasks	Referral to Social Work; clarification of concerns; structured problem-solving; challenging black and white thinking about the need to perform domestic tasks; re-assigning priorities.
Family - concerns about children	Listening; acknowledgment of concerns; explanation about children's needs; discussion about the benefits of maintaining routine; reassuring children that they have not caused the cancer.
Emotional - anxiety about chemotherapy	Explanation; identification of automatic thoughts; challenging negative cognitions; relaxation and guided imagery.
Physical - pain	Referral for medical review; exploration of concerns about pain; identifying and challenging misbeliefs e.g. about becoming dependent on analgesia or that use of morphine implies inevitably poor prognosis; relaxation and guided imagery.
Spiritual - shame about dependence, low sense of worth	Dignity-conserving techniques e.g. exploration of past experiences, reflection on strengths; engaging in creative discussion about ways to feel in control; framing assistance as necessary to maintain dignity.