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Accuracy of the Distress Thermometer for home care patients with palliative care needs in Germany

Published online by Cambridge University Press:  26 September 2016

Johannes Wüller ,
Stefanie Küttner ,
Ann Christina Foldenauer ,
Roman Rolke  and
Tania Pastrana
Johannes Wüller
Affiliation:
Home Care Städteregion Aachen, Aachen, Germany
Stefanie Küttner
Affiliation:
Department of Hematology and Internal Oncology, Hospital of Düren, Düren, Germany
Ann Christina Foldenauer
Affiliation:
Department of Medical Statistics, Medical Faculty, RWTH University Aachen, Aachen, Germany
Roman Rolke
Affiliation:
Department of Palliative Medicine, Medical Faculty, RWTH University Aachen, Aachen, Germany
Tania Pastrana*
Affiliation:
Department of Palliative Medicine, Medical Faculty, RWTH University Aachen, Aachen, Germany
*
Address correspondence and reprint requests to: Tania Pastrana, Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. E-mail: tpastrana@ukaachen.de.
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Abstract

Objective:

Our aim was to examine the accuracy of the German version of the Distress Thermometer (DT) compared with the Hospital Anxiety and Depression Scale (HADS) in patients with palliative care needs living at home.

Method:

Ours was a 15-month cross-sectional study beginning in September of 2013 in Germany with consecutive patients cared for by a palliative home care service. The survey was implemented during the initial visit by a home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the DT and HADS were applied, and sociodemographic and medical data were collected.

Results:

A total of 89 persons completed both the HADS and DT questionnaires (response rate = 59.7%; mean age = 67 years; female = 55.1%; married = 65.2%; living home with relatives = 73.0%; oncological condition = 92.1%; Karnofsky Performance Scale [KPS] score: 0–40 = 30.3%, 50–70 = 57.3%, >80 = 6.7%). The mean DT score was 6.3 (±2.3), with 84.3% of participants scoring above the DT cutoff (≥4). The mean HADStotal score was 17.9 (±7.8), where 64% of participants had a total HADS score (HADStotal) ≥15, 51.7% reported anxiety (HADSanxiety ≥ 8), and 73% reported depression (HADSdepression ≥ 8). Using the HADS as a gold standard, a DT cutoff score ≥5 was optimal for identifying severe distress in patients with palliative care needs, with a sensitivity of 93.0%, a specificity of 34.4%, a positive predictive value (PPV) of 73.3%, and likelihood ratios LR+ = 1.42 (<3) and –LR = 0.203 (<0.3).

Significance of results:

The DT performed satisfactorily compared to the HADS in screening for distress in our study and can be employed as an instrument for identification of patients with distress. Consequent to the high prevalence of distress, we recommend its routine use for screening distressed persons at home with palliative care needs in order to offer adequate support.

Keywords

Psychological distressDistress ThermometerHADSHome careGermany
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 3 , June 2017 , pp. 288 - 294
Copyright
Copyright © Cambridge University Press 2016 

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References

REFERENCES

Block, S.D. (2001). Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: The art of the possible. The Journal of the American Medical Association, 285(22), 2898–2905.Google ScholarPubMed
Donovan, K.A., Grassi, L., McGinty, H.L., et al. (2014). Validation of the Distress Thermometer worldwide: State of the science. Psycho-Oncology, 23(3), 241–250.Google Scholar
Gessler, S., Low, J., Daniells, E., et al. (2008). Screening for distress in cancer patients: Is the Distress Thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. Psycho-Oncology, 17(6), 538–547.Google Scholar
Gotze, H., Brahler, E., Gansera, L., et al. (2014). Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care. Supportive Care in Cancer, 22(10), 2775–2782.CrossRefGoogle ScholarPubMed
Gruneir, A., Smith, T.F., Hirdes, J., et al. (2005). Depression in patients with advanced illness: An examination of Ontario complex continuing care using the Minimum Data Set 2.0. Palliative & Supportive Care, 3(2), 99–105.Google Scholar
Gunnarsdottir, S., Thorvaldsdottir, G.H., Fridriksdottir, N., et al. (2012). The psychometric properties of the Icelandic version of the Distress Thermometer and problem list. Psycho-Oncology, 21(7), 730–736.Google Scholar
Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale: A review of validation data and clinical results. Journal of Psychosomatic Research, 42(1), 17–41.Google Scholar
Herschbach, P. & Weis, J. (2008). Screeningverfahren in der Psychoonkologie Testinstrumente zur Identifikation betreuungsbedürftiger Krebspatienten: Eine Empfehlung der PSO für die psychoonkologische Behandlungspraxis [in German]. Available from http://www.dapo-ev.de/fileadmin/templates/pdf/pso_broschuere2.pdf.Google Scholar
Holland, J.C., Anderson, B., Breitbart, W.S., et al. (2013). NCCN clinical practice guidelines in oncology (NCCN guidelines®): Distress management, version 2.2013. Available from http://oralcancerfoundation.org/treatment/pdf/distress.pdf.Google Scholar
Küttner, S., Wueller, J. & Pastrana, T. (2016). How much psychological distress is experienced at home by patients with palliative care needs in Germany using the Distress Thermometer? Palliative & Supportive Care, 1–9. Epub ahead of print Jul 26. Available from http://www.pubfacts.com/search/distress+thermometer.Google ScholarPubMed
Ma, X., Zhang, J., Zhong, W., et al. (2014). The diagnostic role of a short screening tool: The Distress Thermometer. A meta-analysis. Supportive Care in Cancer , 22(7), 1741–1755.CrossRefGoogle Scholar
Mazzocato, C., Stiefel, F., de Jonge, P., et al. (2000). Comprehensive assessment of patients in palliative care: A descriptive study utilizing the INTERMED. Journal of Pain and Symptom Management, 19(2), 83–90.Google Scholar
Mehnert, A., Müller, D., Lehmann, C., et al. (2006). Die deutsche Version des NCCN Distress-Thermometers [in German]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 54(3), 213–223.CrossRefGoogle Scholar
Mitchell, A.J. (2007). Pooled results from 38 analyses of the accuracy of the Distress Thermometer and other ultra-short methods of detecting cancer-related mood disorders. Journal of Clinical Oncology, 25(29), 4670–4681.CrossRefGoogle ScholarPubMed
Mitchell, A.J., Meader, N. & Symonds, P. (2010). Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: A meta-analysis. Journal of Affective Disorders, 126(3), 335–348.CrossRefGoogle ScholarPubMed
Neuwöhner, K., Lindena, G., Bausewein, C., et al. (2011). Assessment of distress with physical and psychological symptoms of patients in German palliative care services. Onkologie, 34(3), 94–8. Epub ahead of print Feb 21. Available from https://www.karger.com/Journal/Issue/255036.Google Scholar
Roth, A.J., Kornblith, A.B., Batel-Copel, L., et al. (1998). Rapid screening for psychologic distress in men with prostate carcinoma: A pilot study. Cancer, 82(10), 1904–1908.Google Scholar
Rouse, S.V. (2007). Using reliability generalization methods to explore measurement error: An illustration using the MMPI-2 PSY-5 scales. Journal of Personality Assessment, 88(3), 264–275.Google Scholar
Sollner, W., DeVries, A., Steixner, E., et al. (2001). How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? British Journal of Cancer, 84(2), 179–185.Google Scholar
Thalén-Lindstrom, A., Larsson, G., Hellbom, M., et al. (2013). Validation of the Distress Thermometer in a Swedish population of oncology patients: Accuracy of changes during six months. European Journal of Oncology Nursing, 17(5), 625–631. Epub ahead of print Jan 20. Available from http://www.pubpdf.com/pub/23832312/The-Distress-Thermometer-in-Spanish-cancer-patients-convergent-validity-and-diagnostic-accuracy.CrossRefGoogle Scholar
Thekkumpurath, P., Venkateswaran, C., Kumar, M., et al. (2008). Screening for psychological distress in palliative care: A systematic review. Journal of Pain and Symptom Management, 36(5), 520–528.Google Scholar
Thekkumpurath, P., Venkateswaran, C., Kumar, M., et al. (2009). Screening for psychological distress in palliative care: Performance of touch screen questionnaires compared with semistructured psychiatric interview. Journal of Pain and Symptom Management, 38(4), 597–605.Google Scholar
Waller, A., Williams, A., Groff, S.L., et al. (2011). Screening for distress, the sixth vital sign: Examining self-referral in people with cancer over a one-year period. Psycho-Oncology, 22(2), 388–395. Epub ahead of print Dec 2. Available from http://onlinelibrary.wiley.com/doi/10.1002/pon.v22.2/issuetoc.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.Google Scholar