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Which items on the distress thermometer problem list are the most distressing?

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The importance of distress identification and management in oncology has been established. We examined the relationship between distress and unmet bio-psychosocial needs, applying advanced statistical techniques, to identify which needs have the closest relationship to distress.

Methods

Oncology outpatients (n = 1066) undergoing QUICATOUCH screening in an Australian cancer centre completed the distress thermometer (DT) and problem list (PL). Principal component analysis (PCA), logistic regression and classification and regression tree (CART) analyses tested the relationship between DT score (at a cut-off point of 4) and PL items.

Results

Sixteen items were reported by <5 % of participants. PCA analysis identified four major components. Logistic regression analysis indicated three of these component scores, and four individual items (20 items in total) demonstrated a significant independent relationship with distress. The best CART model contained only two PL items: ‘worry’ and ‘depression’.

Conclusions

The DT and PL function as intended, quantifying negative emotional experience (distress) and identifying bio-psychosocial sources of distress. We offer two suggestions to minimise PL response time whilst targeting PL items most related to distress, thereby increasing clinical utility. To identify patients who might require specialised psychological services, we suggest the DT followed by a short, case-finding instrument for patients over threshold on the DT. To identify other important sources of distress, we suggest using a modified PL of 14 key items, with the 15th item ‘any other problem’ as a simple safety net question. Shorter times for patient completion and clinician response to endorsed PL items will maximise acceptance and clinical utility.

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Acknowledgments

QUICATOUCH was developed with funding from the Cancer Institute NSW. The authors would like to thank the screening assistants, Kylie Harris and Kerrie Gleeson, who had a central role in making this initiative a success.

Author information

Authors and Affiliations

  1. Psycho-Oncology Service, Calvary Mater Newcastle, Newcastle, Australia

    Kerrie Ann Clover, Louise Nelson, Kerry Rogers & Gregory Carter

  2. Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, Australia

    Kerrie Ann Clover & Gregory Carter

  3. Clinical Research Design, Information Technology and Statistical Support (CReDITSS), Hunter Medical Research Institute, Newcastle, Australia

    Christopher Oldmeadow

  4. Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicester, UK

    Alex J Mitchell

Authors
  1. Kerrie Ann Clover
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  2. Christopher Oldmeadow
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  3. Louise Nelson
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  4. Kerry Rogers
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  5. Alex J Mitchell
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  6. Gregory Carter
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Corresponding author

Correspondence to Kerrie Ann Clover.

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Conflict of interest

The authors declare that they have no conflict of interest. Dr. Clover has a full control of all primary data and agrees to allow the journal to review the data if requested.

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Appendices

Appendix 1

Table 2 Problem list items used in the study
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Appendix 2

Table 3 Final list of 15 suggested PL items to retain
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Clover, K.A., Oldmeadow, C., Nelson, L. et al. Which items on the distress thermometer problem list are the most distressing?. Support Care Cancer 24, 4549–4557 (2016). https://doi.org/10.1007/s00520-016-3294-z

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  • DOI: https://doi.org/10.1007/s00520-016-3294-z

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