Feasibility of brief psychological distress screening by a community-based telephone helpline for cancer patients and carers

Abstract

BackgroundUp to one-third of people affected by cancer experience ongoing psychological distress and would benefit from screening followed by an appropriate level of psychological intervention. This rarely occurs in routine clinical practice due to barriers such as lack of time and experience. This study investigated the feasibility of community-based telephone helpline operators screening callers affected by cancer for their level of distress using a brief screening tool (Distress Thermometer), and triaging to the appropriate level of care using a tiered model.MethodsConsecutive cancer patients and carers who contacted the helpline from September-December 2006 (n = 341) were invited to participate. Routine screening and triage was conducted by helpline operators at this time. Additional socio-demographic and psychosocial adjustment data were collected by telephone interview by research staff following the initial call.ResultsThe Distress Thermometer had good overall accuracy in detecting general psychosocial morbidity (Hospital Anxiety and Depression Scale cut-off score ≥ 15) for cancer patients (AUC = 0.73) and carers (AUC = 0.70). We found 73% of participants met the Distress Thermometer cut-off for distress caseness according to the Hospital Anxiety and Depression Scale (a score ≥ 4), and optimal sensitivity (83%, 77%) and specificity (51%, 48%) were obtained with cut-offs of ≥ 4 and ≥ 6 in the patient and carer groups respectively. Distress was significantly associated with the Hospital Anxiety and Depression Scale scores (total, as well as anxiety and depression subscales) and level of care in cancer patients, as well as with the Hospital Anxiety and Depression Scale anxiety subscale for carers. There was a trend for more highly distressed callers to be triaged to more intensive care, with patients with distress scores ≥ 4 more likely to receive extended or specialist care.ConclusionsOur data suggest that it was feasible for community-based cancer helpline operators to screen callers for distress using a brief screening tool, the Distress Thermometer, and to triage callers to an appropriate level of care using a tiered model. The Distress Thermometer is a rapid and non-invasive alternative to longer psychometric instruments, and may provide part of the solution in ensuring distressed patients and carers affected by cancer are identified and supported appropriately.

Sensitivity and Specificity of the Distress Thermometer in Screening for Distress in Long-Term Nasopharyngeal Cancer Survivors

“…The dt is a visual analog scale on which participants rate their level of distress in the preceding 7 days from 0 (none) to 10 (extreme). Some studies have suggested that a cut-off score of 4 or more indicates distress 35,36 ; others support a cutoff score of 5 or more 24 . The validity of the Chinese version of the dt was confirmed in a previous study 37 .…”

The Influence of Chemotherapy-Induced Neurotoxicity on Psychological Distress and Sleep Sisturbance in Cancer Patients

“…A high dt score indicates severe distress. Some studies have determined that a cut-off score of 4 or greater indicates distress 40,41 . The validity of the Chinese version of the dt was confirmed in a previous study 42 .…”

Factores relacionados con las diferentes estrategias de afrontamiento al cáncer de mama en pacientes de recién diagnóstico

“…A pesar de esto, la medicina en la actualidad al fraccionarse en diferentes especialidades va perdiendo su visión integradora, y en muchas de las ocasiones la paciente con cáncer de mama es manejada solamente desde el ámbito biológico, por lo que vive de manera personal su duelo, y utiliza sus propios recursos para llevar a cabo el afrontamiento (24,25) . Pocos son los países que tienen dentro de sus sistemas de salud un programa psicooncológico bien estructurado que le permita a estas pacientes tener una visión más adaptativa de su enfermedad (26,27) . A pesar de que las sociedades han cambiado, las investigaciones relacionadas con los factores psicosociales (28) y familiares (29,30) que influyen en la capacidad de afrontamiento y el incremento de la calidad de vida del paciente y su familia no se han actualizado (21,22) .…”