Screening and referral for psychosocial distress in oncologic practice

Abstract

BACKGROUND. The objectives of this study were to validate the Distress Thermometer (DT) in the Netherlands and to examine its correspondence with a 46‐item Problem List, possible risk factors, and the wish for a referral. METHODS. A cross‐sectional group of 277 cancer patients who were treated at 9 hospitals filled in the DT and the Hospital Anxiety and Depression Scale and rated the presence and severity of problems (response rate, 49%). RESULTS. Receiver operating characteristic analyses identified an ideal cutoff score of 5 on the DT with a positive predictive value of 39% and a negative predictive value of 95%. The Problem List appeared to be a reliable measure. Five items on the Problem List correlated strongly with the DT, 13 items had a moderately strong correlation, 26 items were correlated weakly, and 2 items were not correlated significantly. Emotional control, nervousness, pain, and physical fitness appeared to contribute independently to the DT score. The percentage of patients scoring ≥5 (n = 118 patients; 43%) who wanted (14%) or maybe wanted (29%) a referral was significantly higher than the percentage of patients with DT scores <5 (5% and 13%, respectively) who wanted or maybe wanted a referral. Intensively treated patients reported more distress than those who only underwent surgery. No other clear risk factors for distress were identified. CONCLUSIONS. The DT appeared to be a good instrument for routine screening and ruling out elevated distress. Emotional and physical problems contributed mainly to distress. Experiencing clinically elevated distress did not necessarily suggest that patients wanted a referral. Screening for distress and the wish for a referral can facilitate providing support for those patients who most need and want it. Cancer 2008. © 2008 American Cancer Society.

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

“…A large recent review concluded that no specific screening tool for distress could be recommended [20]. A screening tool which is often used in Dutch hospitals, the distress thermometer (Lastmeter) [26], uses dichotomized questions such as 'do you feel distressed', supplemented with the amount of distress on a scale from 0 to 10. A review including seven randomized trials showed that screening showed an effect on psychological well-being in four of the seven trials [37].…”

“…Furthermore, screening seems to improve communication between health care providers and patients and may enhance psychosocial referrals and facilitate discussions about QoL [20]. However, it is important to be aware that not all patients with a high level of PD want to be referred for an intervention [26]. In a study in 302 cancer patients in Total number of responding paƟents the Netherlands, mostly treated with curative intent, 51% of distressed patients did not need an intervention directly after treatment and 25% were already receiving support.…”

“…It is therefore important to identify patients with high levels of PD early, to increase awareness of both patients and health care professionals on this topic and if wanted, to offer interventions. Most of the current literature on PD was acquired in patients with cancer treated with a curative intent [19,[24][25][26][27][28]. To our knowledge, no studies were performed so far specifically in patients with bone metastases.…”

Desire for psychological support in cancer patients with depression or distress: validation of a simple help question

“…Graves et al [7] found that among 333 lung cancer patients, only 22.5% wanted help with their problems and, even in those with a high rate of distress, only 30% wanted help. In a crosssectional study of cancer patients in the Netherlands, Tuinman et al [8] screened 277 patients using the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). Of those who scored above five on the DT, only 14% definitely wanted to be referred for further help, while 29% would consider a referral.…”

“…Of those who scored above five on the DT, only 14% definitely wanted to be referred for further help, while 29% would consider a referral. Interestingly, of those with low distress, 5% still wanted to be referred and 13% would have considered a referral [8]. Clearly, expression of help is linked with the acceptability of the treatment on offer.…”