START Trial: Structured Triage and Referral by Telephone

Thursday 9 August, 2018

National guidelines trialled in clinical settings recommend the use of supportive care or distress screening in addition to structured care, with preliminary evidence suggesting improvements to patient outcomes and service use 1. To date, no trials have been conducted for individuals using community based services, such as Cancer Council 13 11 20. Such services play a unique role in providing an array of informational, practical and emotional support by telephone.

The START Trial: Structured Triage and Referral by Telephone, focuses on the delivery of (1) distress screening and (2) structured care using a randomised, step-wedged study design. Led by Professor Christine Paul, University of Newcastle, this NHMRC funded project is conducted across Cancer Council 13 11 20 services in New South Wales and Victoria. Randomised across the two sites, consultants and nurses conduct distress screening and referral as per usual practice, or distress screening in addition to administering the Patient Health Questionnaire (PHQ4).

A standardised approach of distress screening is used to assess callers’ emotional wellbeing and to inform referral decisions such as more assessment or for supportive services. For structured care, the PHQ4 is used in addition to distress screening to assess if a person’s distress is related to underlying anxiety or depressive symptoms. Referral pathways to support services are then further tailored, based on answers to these questions.  

The study began in 2017 and also includes follow up calls with participants at three and six-months post intervention. Preliminary data illustrates practical and financial matters in addition to emotional support as the greatest concern to people using the service. Participants have indicated that 13 11 20 services play a role in providing support at all points of the cancer experience, particularly when outside acute or routine clinical care. Further analysis will review if a structured care model improves referral uptake rates and reduces distress levels after 6 months.

  1. Lazenby M (2014) The international endorsement of US distress screening and psychosocial guidelines in oncology: a model for dissemination. Journal of the National Comprehensive Cancer Network. 12: 221-7.


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