Aims
Many patients experiencing significant emotional distress do not seek help and little is known about the reasons for this. We explored the reasons for declining help among patients reporting distress.

Methods
Oncology outpatients reporting significant distress during routine screening were asked if they would like help. Those who declined help were asked their reasons for declining. Available demographic and clinical variables were used to identify factors associated with reasons for declining help.

Results
Of 311 patients with significant distress, 221 (71%) declined help and 215 of these gave a reason for declining professional help. The most common (n=99, 46%) reason was “I prefer to manage myself”. Two other common reasons were “already receiving help” (n=52, 24%) and not believing their distress was severe enough to require help (n=50, 23%). Stigma was rarely cited as a reason for declining help in our sample (n=1, <1%). Also uncommon were “I can’t afford the money [for treatment]” (n=1, <1%) and “I didn’t think anything could help” (n= 12, 6%).

Predictors for declining help were age and gender with younger patients and women more likely to decline help because they were more likely to already be in receipt of help. Distress score and PSYCH-6 scores were significantly lower among patients who rated their distress as not severe enough to require help. Nevertheless, there were patients who had maximal scores on distress and PSYCH in each group.

Conclusions
Two common barriers to patient uptake of available clinical services to help with distress are a preference for self-help and a belief that distress is not sufficiently severe to warrant intervention. These beliefs were held by a proportion of individuals who reported very high levels of distress. Qualitative research and subsequent interventions for overcoming these barriers is required to obtain the most benefit from distress screening programs.