The distress thermometer in survivors of gynaecological cancer: accuracy in screening and association with the need for person-centred support

Abstract

Purpose

Unrecognised psychological distress among cancer survivors may be identified using short screening tools. We validated the accuracy of the distress thermometer (DT) to detect psychological distress on the Hospital Anxiety and Depression Scale (HADS) among early stage gynaecological cancer survivors and whether the women’s DT and HADS scores were associated with the need of an individualised supportive intervention.

Methods

One hundred sixty-five gynaecological cancer survivors answered DT and HADS before randomisation in a trial testing a nurse-led, person-centred intervention using supportive conversations. The number of conversations was decided in the woman-nurse dyad based on the woman’s perceived need. Nurses were unaware of the women’s DT and HADS scores. We validated DT’s accuracy for screening using HADS as gold standard and receiver operating characteristic curves. Associations between DT and HADS scores and the number of conversations received were investigated.

Results

For screening of distress (HADS ≥ 15), a DT score ≥ 2, had a sensitivity of 93% (95% CI 82–98%), a specificity of 40% (32–49%), and positive and negative predictive values of 36% (28–45%), and 94% (84–98%), respectively; area under curve was 0.73 (0.64–0.81). Higher DT and HADS scores were associated with more interventional conversations.

Conclusions

In gynaecological cancer survivors, DT may perform fairly well as a first stage screening tool for distress, but a second stage is likely needed due to a high number of false positives. DT and HADS scores may predict the number of supportive conversations needed in an individualised intervention in gynaecological cancer survivors.