PurposePatients with lung cancer frequently suffer psychological distress and guidelines in the United Kingdom recommend screening of all cancer patients for this problem. The audit investigated use of the Distress Thermometer in terms of staff adherence to locally developed guidelines, patient willingness to use the tool, its impact on referral rates to clinical psychology services and concordance between the tool and the clinical assessment.MethodUse of the Distress Thermometer was audited over a 3-month period in one lung cancer outpatient clinic. Referrals to clinical psychology services in response to clearly delineated referral indicators were assessed. Patient-reported outcomes were compared with practitioner assessment of need during clinical consultations to see whether the tool was measuring distress effectively.ResultsThirty three of 34 patients used the Distress Thermometer during the audit period. Ten reported distress levels above 4 in the emotional or family problems domains. On ten occasions, the clinical interview identified problems not elicited by the Distress Thermometer. Guidelines were adhered to by staff, and patients were offered information about local support services and referral to clinical psychology services where indicated. Whilst all patients were happy to receive written information about further sources of support, none wanted to be referred to psychological services at that time.ConclusionsThe Distress Thermometer is acceptable to patients with lung cancer in outpatient settings but it did not increase referrals for psychological support. Staff found it to be a useful tool in opening up communication about patient issues although it should not replace a comprehensive clinical interview.

This study retests the findings by Leslie & Frith (1988) and Perner, Frith, Leslie & Leekam (1989) that children with autism have a specific difficulty in understanding the principle that ‘seeing leads to knowing’. It extends the earlier work by including a control group of subjects with mental handicap, and by using a simpler method, derived from Pratt & Bryant (1990). Despite these modifications, a very similar result was found: while 75 per cent of the subjects with mental handicap passed this test, only 33 per cent of the subjects with autism did so. This more stringent retest suggests this result is robust.

Previous studies have found a dissociation between two forms of pointing gesture in autism: protoimperative pointing is present, while protodeclarative pointing is absent or impoverished. The latter appears to be part of a joint-attention deficit. In the present study, we searched for a third form, referential pointing, in autism. We predicted that since referential pointing can occur for non-social reasons, and without joint-attention, it might be intact in autism. This prediction was borne out. This new dissociation, intact referential pointing with impaired protodeclarative pointing, suggests that our assessment of this important gesture is becoming more refined, and may hold potential for early diagnosis.

Painful crisis is the most common manifestation of sickle cell disease and accounts for the second greatest number of admissions with an average length of stay of 7 days in central London. Despite this frequency of admissions, the management of pain is fraught with problems. This is not surprising since the psychological challenges presented by sickle cell disease are manifold, resulting in significant psychological distress for some individuals. This paper considers the literature on the psychosocial impact of sickle cell disease, and the American research evidence which suggests that pain management strategies that incorporate a psychological intervention can significantly reduce psychological distress as well as hospital admissions. Britain has been slow to incorporate psychology in the pain management strategies, and we have embarked on research to fill this gap. Although this research constitutes work in progress, an argument is put forward for utilizing the cognitive-behavioural perspective in the management of pain in sickle cell disease and we conclude by giving a brief summary of pilot work which is both the foundation and justification for the current ongoing research.

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