Brief Distress Screening in Clinical Practice: Does it Help to Effectively Allocate Psycho-Oncological Support to Female Cancer Inpatients?

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Abstract

Background: The usefulness of distress screening in cancer inpatient settings has rarely been investigated. This study evaluated a brief distress screening of inpatients in a breast cancer centre and a gynaecological cancer centre. Patients and Methods: Hospitalised patients with breast or gynaecological cancers were screened with the Distress Thermometer. Patients who scored above the cut-off, were referred by the medical staff, or self-referred were offered bedside psycho-oncological counselling. Results: Of 125 patients, 68 (54.4%) received an offer of counselling, and 62 patients (49.6%) accepted. Most of the counselling was induced by distress screening. Only 4 (3.2%) patients self-referred to the counselling service. Of the counselled patients, 65.8% stated that they had substantially benefited from psycho-oncological support; only 5.6% of the non-counselled patients indicated that they might have benefited from psycho-oncological support. Conclusion: Almost all patients who will accept and benefit from psycho-oncological counselling can be identified if distress screening is used in conjunction with referrals by physicians and nurses. Distress screening is a worthwhile component in a framework of psycho-oncological support in a cancer inpatient setting. It paves the way to counselling for cancer inpatients who need it and are willing to accept it but hesitate to self-refer to psycho-oncological services.

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Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders.

Marcia Mitchell (2007)

Ultra-short screening tools involving fewer than five questions have been recommended as a simple method of detecting distress, anxiety, or depression in cancer settings. Such methods have practical appeal, but their diagnostic accuracy is unclear. A literature search limited to diagnostic validity studies of ultra-short screening in cancer settings identified 38 analyses, including 19 assessing the Distress Thermometer alone, involving a total of 6,414 unique patients. The pooled ability of ultra-short methods to detect depression was given by a sensitivity of 78.4%, a specificity of 66.8%, a positive predictive value (PPV) of 34.2%, and a negative predictive value (NPV) of 93.4%. Thus these tools were very good at excluding possible cases of depression but poor at confirming a suspected diagnosis. The pooled ability of ultra-short methods to detect anxiety was given by a sensitivity of 77.3% and a specificity of 56.6% (PPV, 55.2%; NPV, 80.25%) and for distress a sensitivity of 78.3% and a specificity of 66.5% (PPV, 59.7%; NPV, of 82.8%). Results using the Distress Thermometer alone were similar. Scores of integrated accuracy, using the Youden index and diagnostic odds ratio, suggested modest overall accuracy with least success in diagnosing anxiety disorders. Ultra-short methods were modestly effective in screening for mood disorders. Their rule-in ability was poorer than their rule-out ability. Ultra-short methods cannot be used alone to diagnose depression, anxiety, or distress in cancer patients but they may be considered as a first-stage screen to rule out cases of depression.

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

Catherine L Granger, Anthony Glenn, Bert Park … (2011)

Despite documented high rates of psychological distress, it is not clear how to identify those who are willing to accept help. The aim of this study was to investigate whether asking patients receiving chemotherapy if they want help with emotional problems is valuable and to investigate the type of help they want. Patients attending a chemotherapy suite were asked to complete the Hospital Anxiety and Depression Scale, the Brief Patient Health Questionnaire (PHQ) and the Emotion Thermometers tools. Results were compared with a single question on desire for help. In this study, 128 patients completed questionnaires for distress, depression, anxiety and desire for help at initial interview. Only one in five unselected patients had a perceived need for help, and in distressed patients only 36% expressed a desire for help. The addition of the help question to the two questions (PHQ-2) about mood and interest improved the ability to rule-in depression by increasing the specificity. However, by addition of this question, sensitivity was significantly reduced. Desire for help was modestly associated with severity of distress, anxiety and depression. The addition of a help question appears to have limited value in screening for psychological symptoms, but it may highlight those who are willing to accept addition support. Clinicians should attempt to offer a range of psychosocial interventions that will be acceptable to patients with distress. Copyright © 2010 John Wiley & Sons, Ltd.

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Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients.

Stephen Kearing, Karen Gillock, Mark T Hegel … (2008)

Receiving a new diagnosis of breast cancer is a distressing experience that may precipitate an episode of major depressive disorder. Efficient screening methods for detecting depression in the oncology setting are needed. This study evaluated the receiver operating characteristics (ROC) of the single-item Distress Thermometer (DT) for detecting depression in women newly diagnosed with Stage I-III breast cancer. We assessed 321 patients (of 345 consecutive patients) at the time of their pre-surgical consultation at a Comprehensive Breast Cancer Program. Patients were administered the DT along with the Patient Health Questionnaire 9-Item Depression Module (PHQ-9) as a gold standard diagnostic assessment of depression status. Mean DT scores (11-point scale, 0-10) were significantly higher for depressed versus non-depressed patients (8.1 versus 4.4). In ROC analyses the DT showed strong discriminatory power relative to the PHQ-9-derived diagnosis of depression, with an area under the curve of 0.87. Patient age, education, marital status and stage of disease resulted in similar operating characteristics. A score of 7 represented the optimal trade-off between sensitivity (0.81) and specificity (0.85) characteristics for detecting depression. The single-item DT performs satisfactorily relative to the PHQ-9 for detecting depression in newly diagnosed breast cancer patients. A cutoff score of 7 on the DT possesses the optimal sensitivity and specificity characteristics. The strength of these findings suggests that a careful psychosocial evaluation should follow a positive screen.

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Author and article information

Journal

Journal ID (publisher-id): BRC

Journal ID (pmc): BRC

Journal ID (doi): 10.1159/issn.1661-3791

Title: Breast Care

Publisher: S. Karger AG

ISSN (Print): 1661-3791

ISSN (Electronic): 1661-3805

Publication date Subscription-year: 2014

Publication date (Print): May 2014

Publication date (Electronic): 08 April 2014

Volume: 9

Issue: 2

Page: 129

Affiliations

Department of Gynaecology and Obstetrics and Comprehensive Cancer Center, Ludwig Maximilian University, Munich, Germany

Article

Publisher ID: 360788 Pmcid ID: PMC4038311 Other ID: Breast Care 2014;9:129-133

DOI: 10.1159/000360788

PMC ID: PMC4038311

PubMed ID: 24944557

SO-VID: 7086d681-98c5-49b0-93a5-cc77baaef3d3

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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Brief Distress Screening in Clinical Practice: Does it Help to Effectively Allocate Psycho-Oncological Support to Female Cancer Inpatients?

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Most cited references 14

Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders.

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

Sensitivity and specificity of the Distress Thermometer for depression in newly diagnosed breast cancer patients.

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