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Netherlands Cancer Institute, this screening instrument is implemented by oncology nurses and case managers. The Distress thermometer, given in figure B, is a validated screening instrument (Tuinman, Gazendam-Donofrio et al. 2007, Tuinman, Gazendam-Donofrio et al. 2008) which consists of a thermometer indicating the level of distress and an additional problem list. The problem list contains 35 problems/symptoms, for which patients can indicate with yes or no whether they experience them. With a cut-off point of 5, the problem list immediately indicates in which areas patients may be experiencing problems (Tuinman, Gazendam-Donofrio et al. 2008, IKNL-c 2010). It is recommended that the Distress thermometer be administered at the start and end of treatment and every three months during the follow-up phase (IKNL-c 2010). With a score of <5 it is recommended that the results and indicated problems be discussed shortly with the patient. Should the patient indicate a need for psychosocial care, even though their score is lower than the cut-off point, this should be arranged. With a score of >5 a careful inventory of psychosocial problems, referral to a specialised health care professional and discussion in a multidisciplinary meeting are recommended, as is indeed the case at the Netherlands Cancer Institute (IKNL-c 2010).\u000DFigure B: Distress thermometer and problem list\u000D5.7.3 Diagnosing psychosocial problems\u000DThe diagnosing and monitoring of psychosocial problems is performed with questionnaires. The Netherlands Cancer Institute - Antoni van Leeuwenhoek uses the Distress thermometer, the Hospital Anxiety and Depression Scale (HADS), the Somatic Awareness Questionnaire (SAQ), and the short form of the Five Facet Mindfulness Questionnaire (FFMQ-SF). The HADS is the most commonly used instrument to measure distress; at the Netherlands Cancer Institute it is used by the specialised health care professional as part of their diagnostic procedure (Zigmond and Snaith 1983). The HADS was developed specifically for use in somatic populations and lists no items that overlap with physical\u000D135\u000D