title: Screening and referral for psychosocial distress in oncologic practice: use of the Distress Thermometer.
abstract: BACKGROUND
  The objectives of this study were to validate the Distress Thermometer (DT) in the Netherlands and to examine its correspondence with a 46-item Problem List, possible risk factors, and the wish for a referral.
  
  
  METHODS
  A cross-sectional group of 277 cancer patients who were treated at 9 hospitals filled in the DT and the Hospital Anxiety and Depression Scale and rated the presence and severity of problems (response rate, 49%).
  
  
  RESULTS
  Receiver operating characteristic analyses identified an ideal cutoff score of 5 on the DT with a positive predictive value of 39% and a negative predictive value of 95%. The Problem List appeared to be a reliable measure. Five items on the Problem List correlated strongly with the DT, 13 items had a moderately strong correlation, 26 items were correlated weakly, and 2 items were not correlated significantly. Emotional control, nervousness, pain, and physical fitness appeared to contribute independently to the DT score. The percentage of patients scoring > or =5 (n = 118 patients; 43%) who wanted (14%) or maybe wanted (29%) a referral was significantly higher than the percentage of patients with DT scores <5 (5% and 13%, respectively) who wanted or maybe wanted a referral. Intensively treated patients reported more distress than those who only underwent surgery. No other clear risk factors for distress were identified.
  
  
  CONCLUSIONS
  The DT appeared to be a good instrument for routine screening and ruling out elevated distress. Emotional and physical problems contributed mainly to distress. Experiencing clinically elevated distress did not necessarily suggest that patients wanted a referral. Screening for distress and the wish for a referral can facilitate providing support for those patients who most need and want it.
authors.affiliation: Comprehensive Cancer Center North-Netherlands, Groningen, The Netherlands.
authors.forename: Marrit A
authors.initials: MA
authors.lastname: Tuinman
authors.forename: Stacey M
authors.initials: SM
authors.lastname: Gazendam-Donofrio
authors.forename: Josette E
authors.initials: JE
authors.lastname: Hoekstra-Weebers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000379:methods*; D012017:Referral and Consultation; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis*