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

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Can the Distress Thermometer be improved by additional mood domains? Part II. What is the optimal combination of Emotion Thermometers?

PURPOSE: To examine the added value of an algorithmic combination of visual-analogue thermometers compared with the Distress Thermometer (DT) when attempting to detect depression, anxiety or distress in early cancer. METHODS: We report Classification and Regression Tree and logistic regression analyses of the new five-domain Emotion Thermometers tool. This is a combination of five visual-analogue scales in the form of four mood domains (distress, anxiety, depression, anger) as well as need for help. 130 patients attending for their first chemotherapy treatment were assessed. We calculated optimal accuracy for each domain alone and in combination against several criterion standards. RESULTS: When attempting to diagnose depression the Depression Thermometer (DepT) used alone was the optimal approach, but when attempting to detect broadly defined distress or anxiety then a combination of thermometers was most accurate. The DepT was significantly more accurate in detecting depression than the DT. For broadly defined distress a combination of depression, anger and help thermometers was more accurate than the DT alone. For anxiety, while the anxiety thermometer (AnxT) improves upon the DT alone, a combination of the DepT and AnxT are optimal. In each case the optimal strategy allowed the detection of at least an additional 9% of individuals. However, combinations are more laborious to score. In settings where the simplest possible option is preferred the most accurate single thermometer might be preferable as a first stage assessment. CONCLUSION: The DT can be improved by specific combinations of simple thermometers that incorporate depression, anxiety, anger and help.

Can the Distress Thermometer be improved by additional mood domains? Part I. Initial validation of the Emotion Thermometers tool.

PURPOSE: To examine the value of a new screening instrument in a visual-analogue format. METHODS: We report the design and validation of a new five-dimensional tool called the Emotion Thermometers (ET). This is a combination of five visual-analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help). Between March and August 2007, 130 patients attending the chemotherapy suite for their first chemotherapy treatment were asked to complete several questionnaires with validation for distress, anxiety and depression. RESULTS: Of 81 with low distress on the Distress Thermometer (DT), 51% recorded emotional difficulties on the new ET tool, suggesting added value beyond the DT alone. Of those with a broadly defined emotional complication, 93.3% could be identified using the Anxiety Thermometer (AnxT) alone, compared with 54.4% who would be recognized using the DT alone. Using a cut-off of 3v4 on all thermometers against the total Hospital Anxiety and Depression Scale (HADS) score (cut-off 14v15), the optimal thermometer was the Anger Thermometer (sensitivity 61%, specificity 92%). Against HADS anxiety scale, the optimal thermometer was AnxT (sensitivity 92%, specificity 61%) and against the HADS depression scale, the optimal thermometer was the Depression Thermometer (DepT; sensitivity 60%, specificity 78%). Finally, against DSM-IV major depression, the optimal thermometer was the DepT (sensitivity 80%, specificity 79%). Further improvements may be possible by using a combination of thermometers or by repeating the screen. CONCLUSION: The diagnostic accuracy of the DT can be improved by the inclusion of simple addition linear domains without substantially increasing the time needed to apply the test.