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Table 2 Key themes and illustrations related to helpline operator-perceived benefits and challenges of utilising the Distress Thermometer (DT) and Problem List PL), and utility in triage

From: Acceptability of the Distress Thermometer and Problem List to community-based telephone cancer helpline operators, and to cancer patients and carers

Key themes Illustrations
Objectivity and structure "a formal record of the person's distress and problems are noted which ensures objectivity and the ability to triage ... to appropriate level of support"
Invites caller to share emotions "reminds Operators to touch base with callers in regards to their emotional state/coping, as well as any other reason they called"; "it provides an opportunity to introduce the query about how callers are copying emotionally by 'normalising' the question"; "demonstrate to the caller our holistic approach to their care and support - we care about their emotional needs at this time"
Identifying distress not readily observed "the rating may indicate to Helpline operator that the event is actually more stressful than what the person is portraying verbally"
Establishes baseline "baseline ... to monitor the callers distress throughout and at end of call"
Awkward to administer "It is sometimes difficult to find an appropriate moment during a call to ask the questions using the actual words in the tool"; "the DT feels clunky to use and is difficult to insert into a conversation when you have established rapport"
Inappropriate with particular callers "the most difficult thing was keeping a distressed caller focused on giving an actual number rather than 'telling their story'"; "callers who do not call for emotional reasons, for example if they call ... for practical reasons such as a transport inquiry'; "there are some callers who are being supported well by family and friends and make it very clear that their call today is purely practical; "find asking those who are newly grieving (loss of loved one) to rate their distress very difficult...sometimes feels like asking them to rate their love for that loved-one"
Difficulty with the DT and PL scales "some callers just don't get the number idea - they use words: 'no its all going alright' or 'a little bit', 'not really'"; "the language is hard for many men to identify with; ie the word 'distress' is not something they can associate with"; "proved difficult in the length of it [the PL] and not all callers wanted to go through it"
Utility in triage  
Objectivity and clear framework "it gave me a clear framework to pursue with the caller which helped them to rate their level of distress and them identify what areas were causing the most distress. This then allowed me to assess gaps in knowledge and support which provided a basis for appropriate referral to services, support or information sources".
Same conclusion without the instrument "in the main, I feel I probably made similar referrals prior to using the distress thermometer"
Clinical skills more valuable than DT "you will have just explored how they are feeling, established a rapport, responded to their needs but are still required to ask this an Operator I am not reliant on an instrument as blunt as this to determine how a person is going emotionally and what is the appropriate level of care for that person"
Not appropriate ALL the time "it's not the this tool is inappropriate ALL of the time; in fact, there are times when it is an extremely valuable option to use with callers...what is inappropriate, given the range of calls operators take is to say that it MUST be used all the time"