title: Screening for psychologic distress in ambulatory cancer patients.
abstract: BACKGROUND
  Based on evidence that psychologic distress often goes unrecognized although it is common among cancer patients, clinical practice guidelines recommend routine screening for distress. For this study, the authors sought to determine whether the single-item Distress Thermometer (DT) compared favorably with longer measures currently used to screen for distress.
  
  
  METHODS
  Patients (n = 380) who were recruited from 5 sites completed the DT and identified the presence or absence of 34 problems using a standardized list. Participants also completed the 14-item Hospital Anxiety and Depression Scale (HADS) and an 18-item version of the Brief Symptom Inventory (BSI-18), both of which have established cutoff scores for identifying clinically significant distress.
  
  
  RESULTS
  Receiver operating characteristic (ROC) curve analyses of DT scores yielded area under the curve estimates relative to the HADS cutoff score (0.80) and the BSI-18 cutoff scores (0.78) indicative of good overall accuracy. ROC analyses also showed that a DT cutoff score of 4 had optimal sensitivity and specificity relative to both the HADS and BSI-18 cutoff scores. Additional analyses indicated that, compared with patients who had DT scores < 4, patients who had DT scores > or = 4 were more likely to be women, have a poorer performance status, and report practical, family, emotional, and physical problems (P < or = 0.05).
  
  
  CONCLUSIONS
  Findings confirm that the single-item DT compares favorably with longer measures used to screen for distress. A DT cutoff score of 4 yielded optimal sensitivity and specificity in a general cancer population relative to established cutoff scores on longer measures. The use of this cutoff score identified patients with a range of problems that were likely to reflect psychologic distress.
authors.affiliation: Psychosocial and Palliative Care Program, Moffitt Cancer Center, Tampa, Florida 33612, USA. jacobsen@moffitt.usf.edu
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Donovan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Trask
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Fleishman
authors.forename: James
authors.initials: J
authors.lastname: Zabora
authors.forename: Frank
authors.initials: F
authors.lastname: Baker
authors.forename: Jimmie C
authors.initials: JC
authors.lastname: Holland
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001007:Anxiety; D003863:Depression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013315:Stress, Psychological