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



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.


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.


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.


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.


Distress Cancer Community-based Screening Oncology 



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.


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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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