Screening for distress in cancer patients: Is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study
ABSTRACT A prospective validation study was conducted in 171 consenting patients from oncology and palliative care outpatient clinics to validate the Distress Thermometer (DT) against the Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12) and Brief Symptom Inventory-18 (BSI-18) at baseline, four weeks and eight weeks.
Receiver Operating Characteristic analysis was used to examine the sensitivity and specificity of the DT scores against the clinically significant cut-off scores of the criterion measures reporting 95% confidence intervals. Standardised response means were used to compare DT scores with criterion measures over time.
For a cut-off of 4 vs 5, sensitivity against HADS was 79%, specificity 81%; against GHQ-12, sensitivity was 63%, specificity 83%; and against BSI-18, sensitivity was 88%, specificity 74%. At both four and eight weeks, DT scores tended to change significantly in the same direction as the criterion measures. Ninety-five percent of patients found completing the DT acceptable.
The DT is valid and acceptable for use as a rapid screening instrument for patients in the UK with cancer. Our results indicate that it can be used to monitor change in psychological distress over time, but further work is needed to confirm this. Copyright
- SourceAvailable from: Anna K Nowak
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- "The scale ranges from 0 (no distress) to 10 (extreme distress). Scores of 5 and 6 indicate moderate distress, while scores of 7 or greater indicate high distress . "
ABSTRACT: To determine High Grade Glioma (HGG) patients’ levels of distress and QOL during combined chemoradiotherapy, explore predictors of distress and QOL and prioritize patients’ supportive care needs.Patient Education and Counseling 01/2015; 98(4). DOI:10.1016/j.pec.2015.01.002 · 2.60 Impact Factor
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- "Participants were asked to indicate how much distress they had experienced in the past week on a scale of 0 ('no distress') to 10 ('extreme distress'). The DT has been shown to be a psychometrically sound measure of global psychological distress with cancer patients and carers, with a score of four or above signifying clinically significant distress (Ransom et al. 2006; Gessler et al. 2008; Zwahlen et al. 2008). Levels of anxiety and depression were measured with the self-administered Hospital Anxiety and Depression Scale (HADS). "
ABSTRACT: Within the area of cancer care, mindfulness-based therapeutic interventions have been found to be efficacious in reducing psychological distress related to a cancer diagnosis; however, the impact of mindfulness-based interventions on quality of life is unclear. This study explores the impact of a Mindfulness-Based Cancer Stress Management programme on psychological distress and quality of life. Research methodology included a single-group quasi-experimental study of 26 participants experiencing distress related to a cancer diagnosis, including carers, who completed an MBCSM programme and all assessments. Participants completed the Functional Assessment of Cancer Therapy - General version 4 (FACT-G) and its associated spirituality index (FACIT-Sp-Ex), Hospital Anxiety and Depression Scale (HADS), Freiburg Mindfulness Inventory (FMI), and the Distress Thermometer at baseline, post-intervention, and three months after programme completion. Significant improvements were observed on all measures (ranges: P ≤ 0.001 to 0.008, r = -0.53 to -0.79) following the intervention, which were maintained at 3-month follow-up. Mindfulness was significantly correlated with all main outcome measures at post-intervention (range: r = -0.41 to 0.67) and 3-month follow-up (range: r = -0.49 to 0.73), providing evidence for the internal validity of the study. Our findings indicate that the MBCSM programme is effective in reducing psychological distress and improving quality of life, including spiritual well-being.European Journal of Cancer Care 10/2013; DOI:10.1111/ecc.12136 · 1.76 Impact Factor
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- "Patients in one study noted that it was the first time they were asked about a number of issues . Gessler et al. (2008) surveyed oncology and palliative care outpatients and found that 95% of respondents did not find completing the instrument upsetting in any way and 86% did not consider any changes were required to its current form . Fulcher et al. (2007) reported that overall, patients were receptive to completing the tool with satisfaction ratings ("clinic's sensitivity to your needs " ) increasing from 88.1% to 92.6% following its introduction . Further, health professionals indicated that the introduction of screening helped direct or prioritise interventions and referrals   and did not substantially burden the clinics or referral agencies . "
ABSTRACT: Cancer can be a distressing experience for cancer patients and carers, impacting on psychological, social, physical and spiritual functioning. However, health professionals often fail to detect distress in their patients due to time constraints and a lack of experience. Also, with the focus on the patient, carer needs are often overlooked. This study investigated the acceptability of brief distress screening with the Distress Thermometer (DT) and Problem List (PL) to operators of a community-based telephone helpline, as well as to cancer patients and carers calling the service. Operators (n = 18) monitored usage of the DT and PL with callers (cancer patients/carers, >18 years, and English-speaking) from September-December 2006 (n = 666). The DT is a single item, 11-point scale to rate level of distress. The associated PL identifies the cause of distress. The DT and PL were used on 90% of eligible callers, most providing valid responses. Benefits included having an objective, structured and consistent means for distress screening and triage to supportive care services. Reported challenges included apparent inappropriateness of the tools due to the nature of the call or level of caller distress, the DT numeric scale, and the level of operator training. We observed positive outcomes to using the DT and PL, although operators reported some challenges. Overcoming these challenges may improve distress screening particularly by less experienced clinicians, and further development of the PL items and DT scale may assist with administration. The DT and PL allow clinicians to direct/prioritise interventions or referrals, although ongoing training and support is critical in distress screening.BMC Cancer 01/2011; 11:46. DOI:10.1186/1471-2407-11-46 · 3.32 Impact Factor