Lisa Graham-Wisener1, Martin Dempster1, Aaroon Sadler2, Luke McCann3, Noleen K McCorry4. 1. Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK. 2. Marie Curie Hospice Belfast, Belfast, UK. 3. South Eastern Health and Social Care Trust, Ulster Hospital, Dundonald, Downpatrick, UK. 4. Centre of Excellence in Public Health, Queen's University Belfast, Belfast, UK.
Abstract
BACKGROUND: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. AIM: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. DESIGN: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. SETTING/PARTICIPANTS: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. RESULTS: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. CONCLUSIONS: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.
BACKGROUND: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. AIM: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. DESIGN: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. SETTING/PARTICIPANTS: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. RESULTS: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. CONCLUSIONS: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.
Authors: Jimmie C Holland; Barbara Andersen; William S Breitbart; Bruce Compas; Moreen M Dudley; Stewart Fleishman; Caryl D Fulcher; Donna B Greenberg; Carl B Greiner; George F Handzo; Laura Hoofring; Paul B Jacobsen; Sara J Knight; Kate Learson; Michael H Levy; Matthew J Loscalzo; Sharon Manne; Randi McAllister-Black; Michelle B Riba; Kristin Roper; Alan D Valentine; Lynne I Wagner; Michael A Zevon Journal: J Natl Compr Canc Netw Date: 2010-04 Impact factor: 11.908
Authors: Barbara L Andersen; Robert J DeRubeis; Barry S Berman; Jessie Gruman; Victoria L Champion; Mary Jane Massie; Jimmie C Holland; Ann H Partridge; Kate Bak; Mark R Somerfield; Julia H Rowland Journal: J Clin Oncol Date: 2014-04-14 Impact factor: 44.544
Authors: Emma Carduff; Sarah Johnston; Catherine Winstanley; Jamie Morrish; Scott A Murray; Juliet Spiller; Anne Finucane Journal: BMC Palliat Care Date: 2018-01-04 Impact factor: 3.234
Authors: Sarah Cox; Fliss E M Murtagh; Adrian Tookman; Andrew Gage; Nigel Sykes; Maureen McGinn; Meeta Kathoria; Hilary Wilderspin; Liz Chart Journal: London J Prim Care (Abingdon) Date: 2016-12-26
Authors: Emma J Chapman; Simon Pini; Zoe Edwards; Yousuf Elmokhallalati; Fliss E M Murtagh; Michael I Bennett Journal: BMC Palliat Care Date: 2022-02-04 Impact factor: 3.234