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.
Journal of the National Cancer Institute (Impact Factor: 12.58). 10/2009; 101(21):1464-88. DOI: 10.1093/jnci/djp336
Source: PubMed


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.

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Available from: Andrea Vodermaier
    • " originally developed by the National Comprehensive Cancer Network ( NCCN ) , and adapted for UK patients by Brennan et al . ( 2012 ) . The NCCN ( 2014 ) recommend that a distress thermometer score of 4 or more is evidence of moderate to severe dis - tress . It has been widely used and its psychometric proper - ties have been extensively studied ( Vodermaier et al . 2009 ) ."
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    ABSTRACT: The aim of this study was to identify the distress, unmet needs and concerns of head and neck cancer (HNC) survivors in the first 5 years after treatment. Two hundred and eighty HNC survivors from three Scottish health boards responded to a cross-sectional postal survey in 2011. Questionnaires included the Distress Thermometer, Patient Concerns Inventory (PCI) and an adapted version of the PCI to measure unmet needs. One-third of the survivors had moderate or severe levels of distress, and 74% had at least one unmet need. The most common concerns and unmet needs included oral and eating problems, fear of recurrence and fatigue. Multivariate analysis revealed that being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs. The diversity of concerns and unmet needs identified in this study highlights the importance of holistic needs assessment as part of follow-up care for HNC survivors with tailoring of support for particular concerns. Specific information resources and self-management strategies are required to help HNC survivors with the practical and functional consequences of HNC treatment. © 2015 John Wiley & Sons Ltd.
    No preview · Article · Jul 2015 · European Journal of Cancer Care
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    • "This dimension measures feelings of inadequacy and inferiority, particularly in comparison to other people, self-deprecation, self-doubt, and marked discomfort during interpersonal interactions. The SCL-90-R has historically shown good internal consistency and test–retest reliability (Schmitz et al., 2000; Vodermaier, Linden, & Siu, 2009), although the validity in terms of factor structure of the dimensions has led to contradictory results (Olsen, Mortensen , & Bech, 2004; Schmitz et al., 2000). In the present study, the internal consistency was acceptable for all subcales at any assessment wave included in the analysis, that is, 1988, 1993, 1999, and 2008. "
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    ABSTRACT: Although dyspareunia has a major impact on sexual and general wellbeing, there are few data on the longitudinal development of its prevalence in representative study groups. Therefore, it was the aim of the present study to fill this gap by evaluating the prevalence of dyspareunia in a representative sample at age 30, 35, 41, and 50. Additional aims were to determine the association between dyspareunia, psychopathological covariates, personality characteristics, and coping resources. Semi-structured interviews with single-item questions on sexual problems in general as well as dyspareunia were used to gain information on 1-year as well as long-time prevalence rates. Psychopathological covariates were explored with the SCL-90-R. The Freiburger Personality Inventory (Freiburger Persönlichkeits Inventar, FPI) assessed personality characteristics. Scales of sense of mastery and self-esteem were used to investigate coping resources. Twelve months prevalence of dyspareunia varied between 4.5 and 6.4 % with a mean of 5.6 % and a long-time risk of 19.3 %. No relation between age and the prevalence rates was found. Dyspareunia was related to psychopathological covariates, especially depression. With respect to personality traits as measured with the FPI only nervousness showed a significant association with dyspareunia, whereas coping resources were unrelated. As dyspareunia is experienced by about 20 % of all women, it represents a frequent sexual problem. Therefore, assessment of dyspareunia should be integrated into primary care of women at any age and diagnostic as well as therapeutic strategies should be based on physiological and psychological factors.
    Full-text · Article · Jan 2015 · Archives of Sexual Behavior
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    • "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]. "
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    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.
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