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Accuracy of the Distress Thermometer for home care patients with palliative care needs in Germany

Published online by Cambridge University Press:  26 September 2016

Johannes Wüller ,
Stefanie Küttner ,
Ann Christina Foldenauer ,
Roman Rolke  and
Tania Pastrana
Johannes Wüller
Affiliation:
Home Care Städteregion Aachen, Aachen, Germany
Stefanie Küttner
Affiliation:
Department of Hematology and Internal Oncology, Hospital of Düren, Düren, Germany
Ann Christina Foldenauer
Affiliation:
Department of Medical Statistics, Medical Faculty, RWTH University Aachen, Aachen, Germany
Roman Rolke
Affiliation:
Department of Palliative Medicine, Medical Faculty, RWTH University Aachen, Aachen, Germany
Tania Pastrana*
Affiliation:
Department of Palliative Medicine, Medical Faculty, RWTH University Aachen, Aachen, Germany
*
Address correspondence and reprint requests to: Tania Pastrana, Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. E-mail: [email protected].
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Abstract

Objective:

Our aim was to examine the accuracy of the German version of the Distress Thermometer (DT) compared with the Hospital Anxiety and Depression Scale (HADS) in patients with palliative care needs living at home.

Method:

Ours was a 15-month cross-sectional study beginning in September of 2013 in Germany with consecutive patients cared for by a palliative home care service. The survey was implemented during the initial visit by a home care team. Patients were excluded if they were under 18 years of age, mentally or physically unable to complete the assessment questionnaires as judged by their healthcare worker, or unable to understand the German language. During the first encounter, the DT and HADS were applied, and sociodemographic and medical data were collected.

Results:

A total of 89 persons completed both the HADS and DT questionnaires (response rate = 59.7%; mean age = 67 years; female = 55.1%; married = 65.2%; living home with relatives = 73.0%; oncological condition = 92.1%; Karnofsky Performance Scale [KPS] score: 0–40 = 30.3%, 50–70 = 57.3%, >80 = 6.7%). The mean DT score was 6.3 (±2.3), with 84.3% of participants scoring above the DT cutoff (≥4). The mean HADStotal score was 17.9 (±7.8), where 64% of participants had a total HADS score (HADStotal) ≥15, 51.7% reported anxiety (HADSanxiety ≥ 8), and 73% reported depression (HADSdepression ≥ 8). Using the HADS as a gold standard, a DT cutoff score ≥5 was optimal for identifying severe distress in patients with palliative care needs, with a sensitivity of 93.0%, a specificity of 34.4%, a positive predictive value (PPV) of 73.3%, and likelihood ratios LR+ = 1.42 (<3) and –LR = 0.203 (<0.3).

Significance of results:

The DT performed satisfactorily compared to the HADS in screening for distress in our study and can be employed as an instrument for identification of patients with distress. Consequent to the high prevalence of distress, we recommend its routine use for screening distressed persons at home with palliative care needs in order to offer adequate support.

Keywords

Psychological distressDistress ThermometerHADSHome careGermany
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 3 , June 2017 , pp. 288 - 294
Copyright
Copyright © Cambridge University Press 2016 

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