title: Validity, specificity, feasibility and acceptability of a brief pediatric distress thermometer in outpatient clinics.
abstract: Psychosocial distress is under-recognized in children with cancer and other serious medical illnesses because of a focus on pressing medical concerns.
  
  
  
  This study assessed the validity, inter-rater reliability, sensitivity/specificity, acceptability, and feasibility of administration of a pediatric distress thermometer (DT) designed to screen for the presence of psychosocial distress in youth with serious medical illnesses.
  
  
  
  Two hundred eighty-one patient-caregiver-provider triads were enrolled from two hospital outpatient clinics. Patients diagnosed with cancer and other life-threatening diseases, caregivers, and providers completed the DT and a DT acceptability rating. Patients and caregivers completed standardized measures of anxiety, depression, pain, and fatigue. Providers completed a measure of disease severity. Data collectors completed a feasibility rating.
  
  
  
  The DT was significantly correlated with both caregiver and patient reports of depression, anxiety, pain, and fatigue, exhibiting concurrent validity. Parent, child, and caregiver report demonstrated significant, moderate inter-rater reliability, with lower concordance between raters in the youngest age group. The DT is a sensitive instrument for screening of psychosocial distress when compared with the selected gold standard (Brief Symptom Inventory 18 depression subscale and the Children's Depression Inventory). The DT is not highly specific but quickly identifies those in need of further psychosocial assessment.
  
  
  
  Screening, using an adapted pediatric DT, is valid, feasible, and acceptable to patients, caregivers, and medical providers across chronic medical illnesses.
  
  
  
  As patient and caregiver reports are not always concordant, both patient and caregiver report of distress are important for the provider to obtain clinically meaningful information to guide interventions. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
authors.affiliation: National Cancer Institute, Pediatric Oncology Branch, Bethesda, MD, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Wiener
authors.affiliation: National Cancer Institute, Pediatric Oncology Branch, Bethesda, MD, USA.
authors.forename: Haven
authors.initials: H
authors.lastname: Battles
authors.affiliation: National Cancer Institute, Pediatric Oncology Branch, Bethesda, MD, USA.
authors.forename: Sima
authors.initials: S
authors.lastname: Zadeh
authors.affiliation: National Cancer Institute, Pediatric Oncology Branch, Bethesda, MD, USA.
authors.forename: Brigitte C
authors.initials: BC
authors.lastname: Widemann
authors.affiliation: National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Maryland
authors.initials: M
authors.lastname: Pao
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D017028:Caregivers / Q000523:psychology; D002648:Child; D002908:Chronic Disease; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires / Q000592:standards*; D013821:Thermometers