Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

NCRS10 - What is the link between distress and dysfunction (Sept10)

1,287 views

Published on

This is an invited presentation from the NCRS 2010 asking "what is the association between distress on the distress thermometer and dysfunction". This help to find a cut-off on the DT based on function.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

NCRS10 - What is the link between distress and dysfunction (Sept10)

  1. 1. NCRS 2010 Validation of the Distress Thermometer using ADL: What is the relationship between distress and dysfunction? Alex Mitchell Karen Lord Paul Symonds Department of Cancer & Molecular Medicine, Leicester Royal Infirmary Department of Liaison Psychiatry, Leicester General Hospital Sept2010 Sept2010
  2. 2. Contents 1. Strengths & limitations of DT 2. How to establish “clinical significance” simply 3. Link between distress and dysfunction 4. Lessons for DT cut-offs
  3. 3. Clinical Significance DSMIV and PHQ9 Includes a question on function
  4. 4. 1. Strengths & limitations of DT Strengths => Mainly Acceptability Limitations => Reliability and Validity
  5. 5. DT vs HADS-T Validity (n=660) Leicester2009 SE SP AUC CUT DT – 71.9% 78.4% 0.814 cut point >=4 AnxT – 75.7% 73.4% 0.821 cut point >=5 DepT – 77.6% 82.2% 0.855 cut point >=3 AngT – 77.5% 77.6% 0.823 cut point >=2 HelpT - 69.1% 80.8% 0.809 cut point >=3
  6. 6. DT vs DSMIV Depression SE SP PPV NPV DTma (2007) 80.9% 60.2% 32.8% 92.9% DTLeicesterBW 82.4% 68.6% 28.0% 98.3% DTLeicesterBSA 100% 59.6% 26.8% 100% BSA = British South Asian MA = meta-analysis (Mitchell 2007 JCO) BW= British White
  7. 7. Distress Thermometer - Please circle the number (0-10) that best describes how much distress you have been experiencing in the past week, including today. - What phone number would you like us to contact you on if necessary? Practicaltick WHICH of the following is a cause of distress: Please Problems Spiritual/ Religious Concerns Physical Problems contd… Childcare Loss of faith Changes in Urination Housing Relating to God Fevers Money Loss of meaning or purpose Skin dry/ itchy in life Transport Nose dry/ congested Work/School Physical problems Tingling in hands/ feet Pain Metallic taste in mouth Family Problems Nausea Feeling swollen Dealing with partner Fatigue Sexual Dealing with children Sleep Hot flushes Getting around Emotional Problems Bathing/ Dressing Depression Breathing Fears Mouth sores Is there anything important you would like to add to the list? Nervousness Eating ___________________________ Sadness Indigestion ___ ___________________________ Worry Constipation ___ Anger Diarrhoea ___________________________ ___
  8. 8. Distress Thermometer DT contains only two anchors In its most common version.
  9. 9. Distress Thermometer – Pooled Table Ransom Tuinman Mitchell Lord Hoffman Gessler Clover Jacobsen Proporti Score 2006 2008 2009 2010 2004 2009 2009 2005 Sum on Zero 68 38 61 123 14 27 65 71 467 18.4% One 72 31 42 68 5 26 39 46 329 12.9% Two 77 22 35 44 5 18 30 54 285 11.2% Three 65 37 42 46 8 23 45 46 312 12.3% Four 51 29 29 30 8 7 21 31 206 8.1% Five 41 46 62 40 11 13 41 48 302 11.9% Six 38 32 23 28 2 16 26 31 196 7.7% Seven 36 21 23 38 2 15 32 16 183 7.2% Eight 18 12 18 29 6 9 19 15 126 5.0% Nine 16 5 8 14 3 3 13 9 71 2.8% Ten 9 4 7 20 4 0 9 13 66 2.6% Sum 491 277 350 480 68 157 340 380 2543 Proportion 19.3% 10.9% 13.8% 18.9% 2.7% 6.2% 13.4% 14.9%
  10. 10. Distress Thermometer – Pooled Making a cut based on distribution frequency alone Proportion Is difficult, or impossible. 20.0% Insignificant Minim al Mild Moderate Severe 18.0% 16.0% 14.0% 12.0% 10.0% 18 .4 % 8.0% 12 .9 % 6.0% 12 .3 % 11.9 % 11.2 % 4.0% 8 .1% 7.7% 7.2 % 5.0 % 2.0% 2 .8 % 2 .6 % 0.0% Zero One Tw o Three Four Five Six Seven Eight Nine Ten 50%
  11. 11. Making a cut based on distribution frequency alone Is difficult, or impossible also for the HADS British Journal of Cancer (2007) 96, 868 – 874
  12. 12. 3. Methods – How to Validate an Cut Point? Establish validity with dysfunction not depression
  13. 13. Distress overlaps with not DepT DT just distress but anxiety and 23% 37% anger 4% 3% 3% DT DepT 7% 1% Non-Nil 8% 0% Nil 9% 59% 41% 4% 1% AnxT 2% AngT 15% 2% AnxT AngT 47% 18%
  14. 14. Sample We analysed data collected from Leicester Cancer Centre from 2008-2010 involving 531 people approached by a research nurse and two therapeutic radiographers. We examined distress using the DT and daily function using the question: “How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?” “Not difficult at all =0; Somewhat Difficult =1; Very Difficult =2; and Extremely Difficult =3”
  15. 15. Of the 293 Non-Nil DepT 23% Virtually no one with depression has neither 0.3% DepT distress nor dysfunction, but many with dysfunction do not have depression 3% 2% 18% Dysfunction Distress 28% 26% 22% Dysfunction Distress 76% 69%
  16. 16. Dysfunction in 531 cancer patients 60.0% 55.7% Chart illustrated distribution 50.0% of dysfunction in unselected cancer patients 40.0% 34.3% 30.0% 20.0% 10.0% 7.3% 2.6% 0.0% Unimpaired Mild Moderate Severe
  17. 17. Unimpaired by DT Score 90.00% 80.00% Chart illustrated unimpaired function by DT score 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 1 2 3 4 5 6 7 8 9 10 11
  18. 18. Mean DT Scores? Unimpaired Mild Moderate Severe Mean DT Score 2.1 4.1 5.9 6.5 Std Deviation 2.54 3.0 2.56 3.59 Sample Size 296 182 39 14 Simplified DT Range* 0-3 4-5 6-7 8-10
  19. 19. DT distribution by Impairment 0.18 0.16 0.14 0.12 0.1 0.08 0.06 0.04 0.02 0 0 1 2 3 4 5 6 7 8 9 10
  20. 20. Distress Thermometer Typically severely impared Typically mod impared Based on the mean levels of Typically mildly impared dysfunction the following anchors are suggested Typically unimpared NB: a lower threshold cut of about 3 seems appropriate None at all
  21. 21. Distress Thermometer Based on the mean levels of dysfunction and typical verbal descriptions of distress the following anchors are suggested Extreme and incapacitating Very Severe and very disabling Moderately Severe and disabling Moderate and quite disabling Moderate and somewhat disabling Mild-Moderate and slight disabling Mild but not particularly disabling Very mild and not disabling Minimal but bearable Minimal and not problematic None at all
  22. 22. Credits & Acknowledgments Karen Lord Leicester Royal Infirmary Elena Baker-Glenn University of Nottingham Paul Symonds Leicester Royal Infirmary Chris Coggan Leicester General Hospital Burt Park University of Nottingham Lorraine Granger Leicester Royal Infirmary Nadia Husain University of Leicester Kufre Sampson Leicester Royal Infirmary For more information www.psycho-oncology.info

×