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Quality of Life Research

, Volume 23, Issue 10, pp 2855–2863 | Cite as

Discriminatory power of a 25-item distress screening tool: a cross-sectional survey of 251 cancer survivors

  • Melissa F. Miller
  • C. Daniel Mullins
  • Eberechukwu Onukwugha
  • Mitch Golant
  • Joanne S. BuzagloEmail author
Article

Abstract

Objective

The objective was to test the discriminatory power of a 25-item distress screening tool for use among cancer survivors. We used a measure of item discrimination to determine which items perform better than others at identifying those at greatest risk of distress.

Methods

A total of 251 members (90 % female, median age 57 years) of a community-based cancer support organization completed a web-based distress screening tool. Participants were asked to rate each of 25 items according to the question “Today, how concerned are you about…?” using a five-point Likert scale (0 not at all to 4 very seriously concerned). An overall distress score was calculated as the sum of items rated at or above two for somewhat concerned. Participants were categorized as high scorers (≥13, n = 59) and low scorers (≤4, n = 60). The item discrimination index (IDI) was calculated for each item as the percentage difference in concerned (somewhat or greater) responses between high and low scorers.

Results

Items with the greatest discriminatory power (IDI ≥0.8) were as follows: changes or disruptions in work, school or home life; feeling sad or depressed; feeling too tired to do the things you need or want to do; worrying about the future and what lies ahead; and feeling nervous or afraid. Conversely, items with the lowest IDI included considering taking your own life; eating and nutrition; tobacco or substance use; and transportation to treatment and appointments.

Conclusion

The results highlight, among 25 items of a community-based distress screening tool, items with the greatest discriminatory power to identify cancer survivors with psychosocial distress. Results suggest targeted screening items to identify those most at risk for distress and priority areas for support services.

Keywords

Distress Cancer Community-based Screening Oncology 

Notes

Acknowledgments

The authors would like to acknowledge the significant contributions of Victoria Kennedy, Christopher Gayer, and Anne Morris from the Cancer Support Community; the local Cancer Support Community affiliates who recruited and supported participants in this study; and Stephanie Singleton, Dynamic Clinical Systems. This study was supported by Grants from Genentech, Pfizer, and Eli Lilly and Company Foundation.

Conflict of interest

The authors report no financial relationships with commercial interests.

References

  1. 1.
    Carlson, L. E., & Bultz, B. D. (2003). Benefits of psychosocial oncology care: Improved quality of life and medical cost offset. Health Qual Life Outcomes, 1, 8.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Stanton, A. L. (2012). What happens now? Psychosocial care for cancer survivors after medical treatment completion. Journal of Clinical Oncology, 30(11), 1215–1220.PubMedCrossRefGoogle Scholar
  3. 3.
    Carlson, L. E., et al. (2012). Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: Randomised controlled trials of computerised vs personalised triage. British Journal of Cancer, 107(4), 617–625.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Carlson, L. E., Waller, A., & Mitchell, A. J. (2012). Screening for distress and unmet needs in patients with cancer: Review and recommendations. Journal of Clinical Oncology, 30(11), 1160–1177.PubMedCrossRefGoogle Scholar
  5. 5.
    Jacobsen, P. B., Holland, J. C., & Steensma, D. P. (2012). Caring for the whole patient: The science of psychosocial care. Journal of Clinical Oncology, 30(11), 1151–1153.PubMedCrossRefGoogle Scholar
  6. 6.
    Institute of Medicine (US) (2008) Committee on psychosocial services to cancer patients/families in a community setting. In N. E. Adler & A. E. K. Page (Eds.), Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press (US). Available from http://www.ncbi.nlm.nih.gov/books/NBK4015/.
  7. 7.
    NCCN Practice Guidelines for the Management of Psychosocial Distress. (1999). National comprehensive cancer network. Oncology (Williston Park), 13(5A), 113–147.Google Scholar
  8. 8.
    American College of Surgeons. (2011). Commission on Cancer, Cancer Program Standards 2012: Ensuring Patient-Centered Care. Chicago, IL: American College of Surgeons.Google Scholar
  9. 9.
    Neuss, M. N., et al. (2005). A process for measuring the quality of cancer care: The quality oncology practice initiative. Journal of Clinical Oncology, 23(25), 6233–6239.PubMedCrossRefGoogle Scholar
  10. 10.
    Rebalance Focus Action Group. (2005). A position paper: Screening key indicators in cancer patients: Pain as a 5th vital sign and emotional distress as a 6th vital sign. Canadian Strategy for Cancer Control Bulletin, 7(suppl), 4.Google Scholar
  11. 11.
    Accreditation Canada. (2009) Cancer care and oncology services standards. http://www.accreditation.ca/accreditation-programs/qmentum/standares/cancer-care.pdf. Accessed May 20, 2009.
  12. 12.
    Department of Health Victoria. (2008). Victorian cancer action plan 2008–2011. Melbourne: Published by the Victorian Government, Department of Human Services.Google Scholar
  13. 13.
    Mosher, C. E., & Duhamel, K. N. (2012). An examination of distress, sleep, and fatigue in metastatic breast cancer patients. Psychooncology, 21(1), 100–107.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Steinberg, T., et al. (2009). Prevalence of emotional distress in newly diagnosed lung cancer patients. Supportive Care in Cancer, 17(12), 1493–1497.PubMedCrossRefGoogle Scholar
  15. 15.
    van Scheppingen, C., et al. (2011). Does screening for distress efficiently uncover meetable unmet needs in cancer patients? Psychooncology, 20(6), 655–663.PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobsen, P. B. (2007). Screening for psychological distress in cancer patients: Challenges and opportunities. Journal of Clinical Oncology, 25, 4526–4527.PubMedCrossRefGoogle Scholar
  17. 17.
    Mitchell, A. J., et al. (2010). Can the distress thermometer be improved by additional mood domains? Part I. Initial validation of the emotion thermometers tool. Psychooncology, 19(2), 125–133.PubMedCrossRefGoogle Scholar
  18. 18.
    Vodermaier, A., Linden, W., & Siu, C. (2009). Screening for emotional distress in cancer patients: A systematic review of assessment instruments. Journal of the National Cancer Institute, 101(21), 1464–1488.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Loscalzo, M., et al. (2010). SupportScreen: A model for improving patient outcomes. Journal of the National Comprehensive Cancer Network, 8, 496–504.Google Scholar
  20. 20.
    Carlson, L. E., & Bultz, B. D. (2004). Efficacy and medical cost offset of psychosocial interventions in cancer care: Making the case for economic analyses. Psychooncology, 13(12), 837–849; discussion, 850–856.Google Scholar
  21. 21.
    Carlson, L. E., Groff, S. L., Maciejewski, O., et al. (2010). Screening for distress in lung and breast cancer outpatients: A randomized controlled trial. Journal of Clinical Oncology, 28, 4884–4891.PubMedCrossRefGoogle Scholar
  22. 22.
    Carlson, L. E., Waller, A., Groff, S. L., et al. (2012). Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: Randomised controlled trial of computerised vs personalised triage. British Journal of Cancer, 107, 617–625.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Miller, M. F., Buzaglo, J. S., Taylor, J., Kennedy, V., Singelton, S., Gayer, C., Golant, M. (2012). Psychometric properties of a 25-item distress screening tool in a community sample of 251 cancer survivors. 6th Biennial Cancer Survivorship Research Conference: Arlington, VA.Google Scholar
  24. 24.
    Buzaglo, J. S., Miller, M. F., Gayer, C., Morris, A., & Golant, M. (2013). CancerSupportSource: Validating a web-based distress screening tool in the community. Journal of the National Comprehensive Cancer Network, 11(3), 242–243.Google Scholar
  25. 25.
    Thiboldeaux, K. G. (2007). The total cancer wellness guide: Reclaiming your life after diagnosis. BenBella: Dallas.Google Scholar
  26. 26.
    Miller, M. F., et al. (2013). Demonstrating the psychometric properties of a problem-related distress screener in a community sample of 319 cancer survivors. Psycho-Oncology, 22(6), 1249–1257.PubMedCrossRefGoogle Scholar
  27. 27.
    Waltz, C. F., Strickland, O. L., & Lenz, E. R. (1991). Measurement in nursing research (Vol. 2). Philadelphia, PA: Davis.Google Scholar
  28. 28.
    Doran, R. (1980). Basic measurement and evaluation of science instruction. Washington, DC: National Science Teachers Association.Google Scholar
  29. 29.
    Aiken, L. R. (1979). Relationships between the item difficulty and discrimination indexes. Educational and Psychological Measurement, 39(4), 821–824.CrossRefGoogle Scholar
  30. 30.
    Tilson, J. K. (2010). Validation of the modified Fresno test: Assessing physical therapists’ evidence based practice knowledge and skills. BMC Medical Education, 10, 38.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Smith, M. K., Wood, W. B., & Knight, J. K. (2008). The genetics concept assessment: A new concept inventory for gauging student understanding of genetics. CBE—Life Sciences Education, 7, 422–430.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Ailinger, R. L., Harper, D. C., & Lasus, H. A. (1998). Bone up on osteoporosis: Development of the facts on osteoporosis quiz. Orthopaedic Nursing, 17(5), 66–73.PubMedCrossRefGoogle Scholar
  33. 33.
    Sedlak, C. A., & Zeller, R. A. (1998). Using item discrimination to improve measurement. Orthopaedic Nursing, 17(5), 71–72.Google Scholar
  34. 34.
    Meyer, T. J., & Mark, M. M. (1995). Effects of psychosocial interventions with adult cancer patients: A meta-analysis of randomized experiments. Health Psychology, 14(2), 101–108.PubMedCrossRefGoogle Scholar
  35. 35.
    Rehse, B., & Pukrop, R. (2003). Effects of psychosocial interventions on quality of life in adult cancer patients: Meta analysis of 37 published controlled outcome studies. Patient Education and Counseling, 50(2), 179–186.PubMedCrossRefGoogle Scholar
  36. 36.
    Sheard, T., & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in cancer patients: Results of two meta-analyses. British Journal of Cancer, 80(11), 1770–1780.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Faller, H., et al. (2003). Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: Systematic review and meta-analysis. Journal of Clinical Oncology, 31(6), 782–793.CrossRefGoogle Scholar
  38. 38.
    Golant, M., & Haskins, N. V. (2008). “Other cancer survivors”: The impact on family and caregivers. Cancer Journal, 14(6), 420–424.CrossRefGoogle Scholar
  39. 39.
    Cohen, G., (2002). Cancer clinical trials: A primer for participation of community physicians. In M. C. Perry (Ed) American Society of Clinical Oncology 2002 Educational Book (pp. 283–289). Baltimore, MD: Lippincott Williams and Wilkins.Google Scholar
  40. 40.
    Edwards, B. K., et al. (2005). Annual report to the nation on the status of cancer, 1975–2002, featuring population-based trends in cancer treatment. Journal of the National Cancer Institute, 97(19), 1407–1427.PubMedCrossRefGoogle Scholar
  41. 41.
    Zabora, J., Brintzenhofeszoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10(1), 19–28.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Melissa F. Miller
    • 1
  • C. Daniel Mullins
    • 2
  • Eberechukwu Onukwugha
    • 2
  • Mitch Golant
    • 1
  • Joanne S. Buzaglo
    • 1
    Email author
  1. 1.Cancer Support Community (CSC) Research and Training InstitutePhiladelphiaUSA
  2. 2.University of Maryland School of PharmacyBaltimoreUSA

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