Distress Thermometer

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Assess your needs - ONLY complete this before your planned telehealth appointment

It can be hard to know what you need help with. To understand how we can best support you, we use the Distress Thermometer and Problem List. The Distress Thermometer shows how much distress you are feeling. The Problem List helps us see what may be causing that distress.

Please enter your name, choose your distress level, and tick any problems you are experiencing. When you press Submit, your answers will be sent to the Support Specialist you have an appointment with.

Please click the number (0-10) that best shows how much distress you have been feeling in the past week including today.

Please tick if any of the following have been a problem for you in the past week including today.

Physical Concerns

Pain

Sleep

Fatigue

Tobacco use

Substance use

Memory or concentration

Sexual Health

Changes in eating

Loss or change of physical abilities

Emotional Concerns

Worry or anxiety

Sadness or depression

Loss of interest or enjoyment

Grief or loss

Fear

Loneliness

Anger

Changes in appearance

Feelings of worthlessness or being a burden

Social Concerns

Relationship with spouse or partner

Relationship with children

Relationship with family members

Relationship with friends or coworkers

Communication with healthcare team

Ability to have children

Prejudice or discrimination

Spiritual or Religious Concerns

Sense of meaning or purpose

Changes in faith or beliefs

Death, dying or afterlife

Conflict between beliefs and cancer treatments

Relationship with the sacred

Ritual or dietary needs