title: Stability and Repeatability of the Distress Thermometer (DT) and the Edmonton Symptom Assessment System-Revised (ESAS-r) with Parents of Childhood Cancer Survivors.
abstract: OBJECTIVE
  Parents report psychological distress in association with their child's cancer. Reliable tools are needed to screen parental distress over the cancer trajectory. This study aimed to estimate the stability and repeatability of the Distress Thermometer (DT) and the Depression and Anxiety items of the Edmonton Symptom Assessment System-revised (ESAS-r-D; -A) in parents of children diagnosed with cancer.
  
  
  METHODS
  Fifty parents (28 mothers, median age = 44) of clinically stable survivors of childhood solid and brain tumours completed questionnaires about their own distress (DT, ESAS-r-D; -A, Brief Symptom Inventory-18: BSI-18, Patient Health Questionnaire-9: PHQ-9, Generalized Anxiety Disorder-7: GAD-7) and their children's quality of life (QoL; Peds Quality of Life: PedsQL) twice, with a month interval between the two assessments. At retest, parents also evaluated life events that occurred between the two time points. Hierarchical regressions explored moderators for the temporal stability of test measures.
  
  
  RESULTS
  Stability estimates were ICC = .78 for the DT, .55 for the ESAS-r-D, and .47 for the ESAS-r-A. Caseness agreement between test and retest was substantial for the DT, fair for the ESAS-r-D, and slight for the ESAS-r-A. Repeatability analyses indicated that the error range for the DT was more than 2 pts below/above actual measurement, whereas it was more than 3 pts for the ESAS-r-A, and 2.5 for the ESAS-r-D. Instability of the DT could be explained by changes in children's physical QoL, but not by other components of QoL or life events. No moderators of stability could be identified for the ESAS-r items.
  
  
  CONCLUSIONS
  The DT appears to be a fairly stable measure when the respondent's condition is stable yet with a relatively wide error range. Fluctuations in distress-related constructs may affect the temporal stability of the DT. The lower stability of ESAS-r items may result from shorter time-lapse instructions resulting in a greater sensitivity to change. Findings support future research on the DT as a reliable instrument in caregivers.
authors.affiliation: Department of Hematology-Oncology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, 3175, Chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.|Department of Psychology, Université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent d'Indy, Montréal, Québec, H2V 2S9, Canada.
authors.forename: Tatsiana
authors.identifier: http://orcid.org/0000-0001-7200-3604
authors.initials: T
authors.lastname: Leclair
authors.affiliation: Department of Hematology-Oncology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, 3175, Chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Carret
authors.affiliation: Department of Hematology-Oncology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, 3175, Chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Samson
authors.affiliation: Department of Hematology-Oncology, Centre Hospitalier Universitaire (CHU) Sainte-Justine, 3175, Chemin de la Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.|Department of Psychology, Université de Montréal, Pavillon Marie-Victorin, 90, avenue Vincent d'Indy, Montréal, Québec, H2V 2S9, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Sultan
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D010290:Parents; D011594:Psychometrics / Q000379:methods; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology; D017741:Survivors; D063189:Symptom Assessment / Q000379:methods; D055815:Young Adult