Background Selecting a measure for oncology distress screening can be challenging. and (vi) healthcare decision making/communication issues. Subscale evaluation reveals good to excellent internal consistency test-retest reliability and convergent divergent and predictive validity. Specificity of individual items was 0.90 and 0.87 respectively for identifying patients with DSM-IV-TR diagnoses of major depression and generalized anxiety disorder. Conclusions Results support use of the James SCS to quickly detect the most frequent and distressing symptoms and AZD4547 concerns of cancer patients. The James SCS is an efficient reliable and valid clinical and research outcomes measure. Introduction Individuals living with cancer experience many psychological physical social and spiritual challenges throughout their journey . Unaddressed these challenges can disrupt cancer treatment  and ultimately negatively impact survival . In order to promote screening and targeted distress interventions screening has become a required standard of the American College of Surgeons Commission on Cancer Accreditation . The National Comprehensive Cancer Network (NCCN) has also published Distress Management Guidelines  which identify the standard of care as regular screening of the level and nature of distress as well as management of AZD4547 distress according to clinical practice guidelines. One of the primary challenges in implementation of these standards is the selection of an instrument that is brief but comprehensive enough to capture the most distressing needs of cancer survivors and facilitate triage to psychosocial spiritual and palliative care providers. The Distress Thermometer (DT) and Problem Checklist  represented an early effort to balance brevity with coverage; and although the DT continues to be used research has brought into question the validity of this method [7 8 Distress is a multi-dimensional concept. There are a variety of standardized measures to evaluate each area of distress AZD4547 but administration of multiple questionnaires can be burdensome to patients and time-consuming for staff. Many quality of life instruments include multiple domains (e.g. physical symptoms emotional well-being and social functioning) but were developed for research purposes limiting their clinical utility. These instruments typically lack well-validated cut-offs to recommend clinical intervention making scoring and interpretation burdensome for busy providers . A measure is needed that reliably captures patients’ most distressing concerns in both research and clinical settings. A major consideration in screening measure selection is adequate coverage of multiple distress domains. Some instruments focus predominantly on physical symptoms [10-12] or psychological problems [13 14 Very few focus specifically on social or spiritual distress despite the clinical significance of these domains [2 15 The National Consensus Project  identifies at least Gpr146 eight domains to improve quality of life including (i) structure and process; (ii) physical; (iii) psychological AZD4547 and psychiatric; (iv) social; (v) spiritual religious and existential; (vi) cultural; (viii) care of the imminently dying; and (viii) ethical and legal aspects of care. Ideally a screening tool would address the first five domains as well as decision making and advance care planning. A final consideration is the response format of the measure. A yes/no response format does not enable a provider to make rapid triage decisions regarding symptom management and referral needs. Other measures assess the frequency or severity of the symptoms or problems reported by cancer survivors (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) ) Functional Assessment of Cancer Therapy-General ). However these response formats can be problematic as survivors experience wide variation in their tolerance for symptoms [19-21] regardless of severity or frequency. For instance some individuals despite high frequency and severity symptoms continue to work or perform activities without interruption whereas others suffer substantially from minor low frequency symptoms. Understanding an individual’s level of distress.