Multidisciplinary interview to assess distress in patients waiting for breast cancer treatments

Marinella Linardos, Stefania Carnevale, Laura Agostini, Daniela Belella


Background: Screening for distress is considered a fundamental goal in cancer care. The literature underlines the need to improve the distress assessment instruments. Our proposal is to identify the main themes/narratives freely emerging during a first interview, 3–5 days after the diagnosis of breast cancer. In our hypothesis, these themes simultaneously represent the patient's main concerns and the initial coping. Our goal is to differentiate different types of distress, through building a list of the most frequent thematic nuclei and, subsequently, differentiating two classes of distress which require different interventions in order to be reduced.
Methods: One thousand five hundred new-diagnosed breast cancer patients have been undergone to the Multidisciplinary Interview few days after the diagnosis. Any criterion about the type of breast cancer has been applied. For each interview, the main narrative nuclei were classified and analysed and their frequency was calculated in the whole group. Subsequently, we subdivided the narrative nuclei into two subgroups based on the type of distress hypothesized: the distress depending on factors related to therapeutic decisions (type A) from those depending on processes of adaptation and coping (type B).
Results: Few days after diagnosis, it is possible to distinguish two different types of distress: indeed, the most frequent distress themes patients talk about are distributed among issues that affect the impact of the disease in personal life (family, marriage, infertility, work) or more directly related to external organizational factors (diagnostic completions, the waiting for therapies) that it can be defined as type B to issues related to decision-making processes about therapeutic strategies to be adopted, type A.
Conclusions: The results show how much distress can be attributed to time-dependent factors (start the therapies or coping processes) but also to variables related to the ability to feel active in decision-making processes, particularly with regard to requests for over- and under-medical treatments. On these latter factors, you can reduce distress through timely communication to the entire team about the interview results and through the involvement of the multidisciplinary team.