Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments

Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4.
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 10/2009; 101(21):1464-88. DOI: 10.1093/jnci/djp336
Source: PubMed

ABSTRACT Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies-Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21-50 items), the Beck Depression Inventory and the General Health Questionaire-28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients-Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Download full-text


Available from: Andrea Vodermaier, Jul 21, 2015
1 Follower
  • Source
    • "Patients were asked to rate on a four-point Likert-scale how often they experienced 20 symptoms during the past month. The CES-D was recommended in a large review of the psychometric properties of 33 scales used to assess psychological distress in cancer patients [37]. The CES-D has demonstrated good psychometric properties in breast cancer patients [38] and has been used across many types of cancer [39]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To analyze whether qualitative themes in breast cancer patients’ self-presentations predicted symptoms of psychological distress and depression in order to improve the consultation process. Methods 97 breast cancer patients gave unstructured, 10-minute self-presentations at their first consultation in a clinical registered trial (CRT identifier: NCT00990977). Self-presentations were categorized thematically and the most prevalent themes investigated as predictors for scores on the Symptom Check-List 90-Revised (SCL-90-R) and the Center for Epidemiological Studies Depression scale (CES-D). Results Among the qualitative themes, only the percentage of words spent on talking about ‘Acceptance-based psychological coping’ was related to symptoms. In regression models controlling for age, education and time since diagnosis, a stronger focus on acceptance-based coping predicted less psychological distress and depression, respectively. A cross-validation including only the first few minutes of speech per patient confirmed these results and supported their practical utility in health consultations. Conclusion Patients’ focus on acceptance-based coping significantly predicted decreased psychological distress and depression, respectively. No other qualitative themes predicted symptoms. Doctor-patient studies may benefit from combined qualitative-quantitative methods. Practice implications While quantitative symptom assessment is important for a consultation, health care providers may improve their understanding of patients by attending to patients’ presentations of acceptance-based psychological coping.
    Patient Education and Counseling 11/2014; 97(2). DOI:10.1016/j.pec.2014.07.020 · 2.60 Impact Factor
  • Source
    • "This assessment was based on reliability, type of criterion measure, and validity (see Vodermaier 2009 42 "
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2015, the American College of Surgeons (ACoS) Commission on Cancer will require cancer centers to implement screening programs for psychosocial distress as a new criterion for accreditation. A joint task force from the American Psychosocial Oncology Society, the Association of Oncology Social Work, and the Oncology Nursing Society developed consensus-based recommendations to guide the implementation of this requirement. In this review, the authors provide recommendations regarding each of the 6 components necessary to meet the ACoS standard: 1) inclusion of psychosocial representation on the cancer committee, 2) timing of screening, 3) method/mode of screening, 4) tools for screening, 5) assessment and referral, and 6) documentation. Cancer 2014. © 2014 American Cancer Society.
    Cancer 10/2014; 120(19). DOI:10.1002/cncr.28750 · 4.90 Impact Factor
  • Source
    • "Considering this overlap and the large proportion of the patients who are reported to suffer from mental morbidity (Helgeson et al., 2004) distinguishing nonpathological distress responses from potential disorder holds a significant weight further emphasized by its bearing on efficient allocation of available healthcare resources (Narrow et al., 2009). Self-report tools such as Hospital Anxiety and Depression Scale [HAD] (Zigmond and Snaith, 1983) and Distress Thermometer [DT] are frequently utilized in screening for distress in cancer patients (Bidstrup et al., 2011; Vodermaier et al., 2009), Screening is primarily based on examining the patient's score against the established thresholds for caseness. The cut off points provided for instruments such as HAD, against which DT has been validated (Thal en-Lindstr€ om et al., 2013), still constitute a conceptual link of severity of distress to probability of disorder (Bjelland et al., 2002; Dunbar et al., 2000). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Psychological distress is prevalent in patients with breast cancer and is viewed as a non-pathological occurrence. Severe distress and mental disorder display a substantial overlap in both conceptual contexts and studies in oncological settings. A domain that may contribute to distinguishing non-pathological distress from signs of potential disorder is the transiency of distress.
    European journal of oncology nursing: the official journal of European Oncology Nursing Society 07/2014; 18(6). DOI:10.1016/j.ejon.2014.06.007 · 1.79 Impact Factor
Show more