The Distress Thermometer: Cutoff Points and Clinical Use

Abstract

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.

Financial toxicity in cancer care: Prevalence, causes, consequences, and reduction strategies

“…The Patient Health Questionnaire for Depression and Anxiety (PHQ‐4) and the NCCN Distress Thermometer are easy‐to‐use tools to identify psychological distress . A score of greater than or equal to three or four are suggested cutoffs on the Distress Thermometer . Both subjective and objective measures of financial toxicity should be included, as objective measurement (such as comparison of OOP cost to income) alone is not reliable …”

Measuring the distress related to delirium in older surgical patients and their relatives

“…4 To date, the research examining the delirium experience has been conducted in heterogeneous patient populations including critical care survivors, orthogeriatric patients, and those receiving end-of-life care, and the quantitative studies have predominantly recruited patients with cancer. It has been incorporated by the National Comprehensive Cancer Network (NCCN) 18 with a suggested optimal cutoff 19 for detecting significant distress of 3. Distress can be even greater in relatives witnessing delirium and may result in longer-term psychological sequelae.…”

“…16,17 The distress thermometer (DT) is a self-completion tool that asks patients to rate how distressed they have felt in the last week on a scale ranging from 0 (not distressed) to 10 (extremely distressed). It has been incorporated by the National Comprehensive Cancer Network (NCCN) 18 with a suggested optimal cutoff 19 for detecting significant distress of 3. When compared against the Hospital Anxiety and Depression Scale (HADS) for detecting anxiety and depression in a sample of patients with cancer and using a cut point of 3, the DT showed sensitivity of 0.84 and specificity 16 of 0.80 with area under the curve (AUC) 0.69.…”

The clinical-care focused psychological interview (CLiC): a structured tool for the assessment of cancer patients’ needs

“…Perceived utility and feasibility of the CLiC were evaluated in a preliminary sample of 30 patients candidate to undergo a radical cystectomy at IEO, who showed high distress on the distress thermometer [46] (a one-item, 11-point Likert scale that ranges from 0, no distress, to 10, extreme distress, and the cut-off considered was >5 points for reporting a high distress), submitted during pre-hospital admission. During pre-hospitalisation, patients are informed by the case manager nurse that they will receive a clinical-care focused psychological interview together with their other appointments (Electrocardiography ECG, pre-anaesthetic interview, surgical visit and blood test).…”