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

UCL Hospitals Gynaecological Oncology Centre, Elizabeth Garrett Anderson Hospital, London, UK.
Psycho-Oncology (Impact Factor: 4.04). 06/2008; 17(6):538-47. DOI: 10.1002/pon.1273
Source: PubMed

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

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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). "
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    • "Patients in one study noted that it was the first time they were asked about a number of issues [24]. 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 [17]. 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 [24]. Further, health professionals indicated that the introduction of screening helped direct or prioritise interventions and referrals [24] [25] and did not substantially burden the clinics or referral agencies [24]. "
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