The Distress Thermometer and Its Validity: A First Psychometric Study in Indonesian Women with Breast Cancer

Iskandarsyah, Aulia; Klerk, Cora de; Suardi, Dradjat R.; Soemitro, Monty P.; Sadarjoen, Sawitri S.; Passchier, Jan

doi:10.1371/journal.pone.0056353

Cited by 43 publications

(48 citation statements)

References 38 publications

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“…20,23 The ET tool used in our study is a multidomain instrument developed by Alex J. Mitchell, MD (University of Leicester, UK) as an improvement over the DT for screening patients for distress, anxiety, and depression. 10 Mitchell's group has done validation studies of the ET on various populations of cancer patients including breast showing the ET to be accurate in reflecting distress, anxiety, and depression.…”

Section: Discussionmentioning

confidence: 99%

Screening for Psychological Distress in Surgical Breast Cancer Patients

et al. 2014

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Background. This pilot study assessed the levels of patient emotional distress and impact on clinic throughput time.Methods. From April through August 2012, 149 breast cancer patients at the Penn State Hershey Breast Center were screened with the emotions thermometer (ET), a patient-rated visual 0-10 scale that measures distress, anxiety, depression, anger, burden, and need for help. Also, patients indicated their most pressing cancer-related concerns. Clinic visit time was computed and compared with a control group. Results. Using a previously validated cut point C4 for any thermometer, we found emotional difficulty in the following proportions: distress 22 %, anxiety 28 %, depression 18 %, anger 14 %, burden 16 %, and need for help 10 %; 35 % scored above the cut point on at least 1 thermometer. We found higher levels of distress in all domains associated with younger age at diagnosis. More extensive surgery (bilateral mastectomy vs unilateral mastectomy vs. lumpectomy) was correlated with higher levels of psychosocial distress. Most often cited concerns, experienced by [20 %, included eating/weight, worry about cancer, sleep problems, fatigue, anxiety, and pain. Mean clinic visit time for evaluable patients screened using the ET (n = 109) was 43.9 min (SD 18.6), compared with 42.6 min (SD 16.2) for the control group (n = 50).Conclusions. Utilizing the ET, more than one-third of women screened met criteria for psychological distress. Younger age at diagnosis and more extensive surgery were risk factors. The ET is a simple validated screening tool that identifies patients in need of further psychological evaluation without impacting clinic throughput time.Breast cancer is the most common non-skin cancer among women, with as many as 1 in 8 women diagnosed in their lifetime. 1 It is second only to lung cancer as the leading cause of death due to cancer among women. Nonetheless, diagnostics and therapeutics for breast cancer-similar to many kinds of cancer-have seen continuing improvements, leading to subsequent improvements in prognosis. Although improved prognosis often equals longer life, it does not necessarily equal improved morbidity. Therefore, there has been increasing recognition of the importance of quality of life. 2 The importance of addressing psychological distress in women with breast cancer has clearly been established. [3][4][5] In fact, the American College of Surgeons Commission on Cancer has mandated that cancer centers implement screening programs for psychosocial distress as a new criterion for accreditation. 6 Yet, barriers to care remain, including underrecognition of the need for psychological care as well as possible inciting factors. Because most conventional scales developed to detect distress and depression are too long for routine use in clinical settings, simple verbal and visual-analog measures have been developed of which the distress thermometer (DT) is perhaps the most well known. [7][8][9][10] Although a significant advance in distress screening, the DT falls short in its ability...

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Section: Discussionmentioning

confidence: 99%

Screening for Psychological Distress in Surgical Breast Cancer Patients

et al. 2014

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“…For example, using Receiver Operating Characteristic (ROC) analyses, research has validated the use of the DT in many cancer populations. A cut off of 6 or higher has been established for intracranial tumors, 5 for breast cancer patients, and 4 for brain cancer patients (Dabrowski et al, 2007; Goebel & Medhorn, 2011; Iskandarsyah et al, 2013; Keir, Calhoun-Eagan, Swartz, Saleh, & Friedman 2008). Optimal DT cut-off scores may also vary over time.…”

Section: Introductionmentioning

confidence: 99%

The Distress Thermometer: Cutoff Points and Clinical Use

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Person

et al. 2017

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Purpose/Objectives The National Comprehensive Cancer Network’s Distress Thermometer (DT) has been adopted as a screening measure to identify and address psychological distress in individuals with cancer. The purpose of the present study was to establish an optimal cut off point in a large heterogeneous sample of cancer patients. A secondary purpose of the study was to examine whether distress as measured by the DT significantly changes across the treatment trajectory (i.e., diagnosis, on treatment, survivorship). Design The present investigation includes secondary analyses of baseline data from a longitudinal parent study examining a computerized psychosocial assessment. Setting Recruitment occurred at three diverse comprehensive cancer centers across the United States. Sample Eight hundred and thirty-six patients at 3 different comprehensive cancer centers with a current or past diagnosis of cancer were enrolled. Main Research Variables The BHS (Behavioral Health Status) index, as well as the DT were administered and compared using ROC analyses. Findings Results support a cutoff score of 3 on the DT to indicate patients with clinically elevated levels of distress. Further, patients who received a diagnosis within the 1-4 weeks prior to the assessment endorsed the highest levels of distress. Conclusions Providers may wish to utilize a cutoff point of 3 to most efficiently identify distress in a large, diverse population of cancer patients. Further, results indicate that patients may experience a heightened state of distress within the 1-4 weeks post-diagnosis as compared to other stages of coping with cancer. Implications for Nursing It is widely understood that nurses carry a heavy burden regarding patient care. It is often a nurse’s responsibility to screen for psychosocial distress, and using a brief technological measure of distress can help streamline this process.

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“…La consistencia interna de la escala global es alta (a=0,90), así como la de sus subescalas (Ansiedad a=0,85 y Depresión a=0,84). Se empleó la puntuación de 15 para discriminar los casos, por haber sido una referencia ampliamente recomendada (9,12,13,15) . Dado que la HADS es a su vez una prueba de cribado, se realizó un segundo análisis en el que se combinó la clasificación realizada por medio de la HADS con una entrevista semiestructurada basada en los criterios diagnósticos DSM-IV (36) .…”

Section: Materialesunclassified

“…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.…”

Section: Introductionunclassified

“…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.…”

Section: Introductionunclassified

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

et al. 2014

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ResumenObjetivo: El Termómetro del Distrés (TD) es una de las pruebas de cribado de malestar emocional más utilizadas y estudiadas en pacientes oncológicos. Sin embargo, genera numerosos falsos positivos. Además, aún no ha sido convenientemente estudiado con población española, ni en muestras de pacientes recién diagnosticados. El presente estudio analiza el rendimiento diagnóstico del TD en una muestra española de pacientes oncológicos recién diagnosticados.Método: Se evaluó el rendimiento diagnós-tico del TD en una muestra de 135 pacientes con diagnóstico oncológico empleando como pruebas de referencia la Escala de Ansiedad y Depresión Hospitalaria (HADS) y una entrevista diagnóstica semiestructurada.Resultados: El TD mostró un rendimiento diagnóstico aceptable (Área Bajo la Curva, ABC=0,79) para detectar malestar emocional usando la HADS como referencia. El punto de corte óptimo fue de 4 puntos (Sensibilidad=0,89; Especificidad=0,56). El rendimiento diagnóstico del TD empleando la combinación de la entrevista clínica y la HADS como referencia fue bueno (ABC=0,86). El punto de corte óptimo fue de 6 puntos (Sensibilidad=0,82; Especificidad=0,76). AbstractObjective: The Distress Thermometer (DT) is one of the most used and studied screening tests of psychological distress in cancer patients. However, it includes many false positives. Furthermore, it has not been adequately studied with Spanish populations or with recently diagnosed patients. This research examines the diagnostic performance of the DT with a sample of Spanish recently diagnosed cancer patients.Method: The diagnostic performance of DT was assessed in a sample of 135 recently diagnosed cancer patients using the Hospital Anxiety and Depression Scale (HADS) and a semi-structured diagnostic interview as gold standard.Results: The diagnostic performance of DT was acceptable (AUC=0.79) to detect psychological distress using the HADS as gold standard. The optimal cut-off score was 4 (Sensitivity=0.89; Specificity=0.56). The diagnostic performance of DT using the HADS plus the diagnostic interview as gold standard was good (AUC=0.86).The optimal cut-off score was 6 (sensitivity=0.82; Specificity=0.76).Discussion: The DT is an appropriate screening test to detect anxiety and depressive disorders in recently diagnosed cancer

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The Distress Thermometer and Its Validity: A First Psychometric Study in Indonesian Women with Breast Cancer

Cited by 43 publications

References 38 publications

Screening for Psychological Distress in Surgical Breast Cancer Patients

Screening for Psychological Distress in Surgical Breast Cancer Patients

The Distress Thermometer: Cutoff Points and Clinical Use

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

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