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The psycho-oncology and social work services recognised that a cancer diagnosis and treatment can result in considerable emotional consequences for patients, yet the referral rate to both services was extremely low. Only very visibly distressed patients were being referred to the service. The “Distress Thermometer” (DT), a distress screening tool, was introduced as a pilot project with day care and inpatient oncology patients of St Vincent ' s University Hospital, Dublin, in an effort to improve the identification, management and treatment of psychological distress in oncology patients. The purpose of this paper is to evaluate the effectiveness of this new intervention.

The Psycho-oncology service in conjunction with the Medical Social Work Department and Nursing Management at St Vincent ' s University Hospital, Dublin, initiated a Distress Education Management and Training Programme (DEMP). The initiative involved providing a training programme for oncology nursing staff and the introduction of a distress-screening tool for patients. In 1998, the DT was developed and validated for evaluation of distress (and depression) in cancer. It was adopted into recommendations made by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with “No distress” and at scale point ten with “Extreme distress”. Patients are given the instruction, “How distressed have you been during the past week on a scale of 0-10”? Patients indicated their level of distress with a mark on the scale. Patients scoring 4 or above were regarded as requiring intervention. The DT includes a problem checklist. The patient is asked to identify those problems from the checklist which are contributing to their score. The use of the DT was evaluated through interviews with patients and professionals.

Patients who scored four or above (38 per cent of patients), were seen by the Oncology Social Worker for psychosocial assessment and mental health triage. Patients who scored above a certain level (usually above 12/20) in the clinical range on the Hospital Anxiety and Depression scale (3 per cent) were referred to Psycho-oncology. That 38 per cent of oncology patients required intervention from a specialist service accurately reflects international findings on the rate of distress among cancer patients.

Assessment of cancer patients ' distress levels in a structured and planned manner with a Distress Thermometer, as recommended by best international practice, works very effectively and should be considered for all cancer out-patients This will have implications in terms of staff that will be required to manage such a service.

This was the first time that this internationally recognised tool was used to such an extent and to positive effect in an Irish context.

Prior to the onset of the COVID-19 pandemic, women did nearly three-quarters of the world’s unpaid work. As institutional supports, including in-person school and community-based care for children, the elderly, and the disabled vanished early in the pandemic, many women’s caregiving responsibilities increased. In some cases, opportunities for paid employment disappeared due to layoffs and furloughs, while in others, paid work was no longer possible without access to the missing institutional supports. Either way, access to needed supports – financial, practical, and social – was diminished. The lapse of needed supports also had severe impacts on subgroups of women, including pregnant and post-partum women. A range of considerations – vaccine safety, social interaction and infection risk, disease severity – have posed serious challenges for pregnant and post-partum women. Across the board, women’s need for continuous access to better social, financial, and practical supports at home, in the community, and in the workplace was made even more evident by the COVID-19 pandemic.

A SPLENDID conference, I thought. True, there were those who complained, those who thought some of the papers were elementary and those who thought that we had come a long way to learn very little. I don't agree at all. Some of the papers did, I admit, deal with basic considerations but it does nothing but good to re‐examine the framework of our services from time to time. In any case other papers were erudite, and for the first time I have seen an audience of librarians and authority members stunned, almost, into silence.