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.

Screening for Distress in Patients with Cancer: Methodologic Considerations

“…Patients use a visual analog thermometer to indicate their level of distress, from 1 (no distress) to 10 (extreme distress), during the preceding week. Clinically significant levels of distress reported in the literature correspond, on average, to scores of 4 or 5 (for example, see Gessler et al 21 ), but actual cut-off scores ranged up to 7 22 . The psychometric properties of the dt for use with cancer patients have largely been investigated 21,23 and have been established across cultures 22,24 .…”

“…Clinically significant levels of distress reported in the literature correspond, on average, to scores of 4 or 5 (for example, see Gessler et al 21 ), but actual cut-off scores ranged up to 7 22 . The psychometric properties of the dt for use with cancer patients have largely been investigated 21,23 and have been established across cultures 22,24 . Although there are discrepancies between the studies, consensus about the predictive validity appears to have been reached: the negative predictive validity (range: 93.4%-95%) is greatly superior to the positive predictive validity (range: 34.2%-39%).…”

El termómetro del distrés como prueba de cribado de ansiedad y depresión en pacientes oncológicos recién diagnosticados

“…El TD ha sido adaptado a distintas lenguas y poblaciones (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) y se ha utilizado para la detección temprana del malestar emocional en pacientes con distintos tipos de cáncer (5,(15)(16)(17)(18) . Se han llevado a cabo estudios de validación utilizando pruebas bien establecidas para la detección de sintomatología ansioso-depresiva como la Escala de Ansiedad y Depresión Hospitalaria (19) o el Inventario Breve de Síntomas (20) , entre otras.…”

“…El primero de estos estudios fue llevado a cabo por Roth et al quienes encontraron una concordancia del 74,4% entre el TD y la HADS utilizando un punto de corte de 5 puntos, en una muestra de 93 pacientes con cáncer de próstata (5) . Sin embargo, no existe acuerdo entre los autores sobre cuál es el punto de corte óptimo que debe utilizarse, que varía en los diferentes estudios (tabla 1), entre 4 (8)(9)(10)(11)17,18,21,22) y 5 puntos (6,12,13,15,(23)(24)(25)(26) . Con el fin de organizar toda la información en este campo, se han llevado a cabo revisiones sistemáticas (27,28) y metaanáli-sis (29,30) para el estudio de la eficacia de los métodos de cribado del malestar emocional en pacientes oncológicos.…”

The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation

“…Visual and analogue scales make discussion of emotions more tangible for clients. For example, the Distress Thermometer (Gessler et al, 2008) and the Emotion Thermometer tools have the advantage of being easy to understand, quick to administer and simple to score, making them relevant for all groups of patients (Mitchell et al, 2010).…”