Cancer Support Community Research and Training Institute, Philadelphia, PA 19131, USA.
Psychooncology. 2013 Jun;22(6):1249-57. doi: 10.1002/pon.3124. Epub 2012 Jun 27.
The purpose was to test the psychometric properties of a 36-item community-based problem-related distress screening tool, among 319 cancer survivors recruited across 14 affiliates of the Cancer Support Community.
Internal reliability was estimated using Cronbach's alpha coefficient. Test-retest reliability was assessed using the intra-class correlation coefficient (ICC). Concurrent validity was determined by correlations with the Functional Assessment of Cancer Therapy-General Well-Being Scale (FACT-G), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Distress Thermometer (DT) and receiver operating characteristic (ROC) curve analysis using the CES-D (≥16) and DT (≥4) as the criterion. Non-parametric analysis of variance was used to establish discriminant validity.
The distress screener demonstrated high internal consistency (Cronbach's alpha = 0.91) and strong test-retest reliability (ICC ≥ 0.75). Summary scores of the distress screener correlated substantially with the FACT-G (R(2) = 0.58, p < 0.001), CES-D (R(2) = 0.48, p < 0.001), and DT (R(2) = 0.35, p < 0.001) indicating strong concurrent validity and were able to discriminate groups of clinical relevance. ROC analyses showed a cutoff score of 8 for problem items rated ≥3 had optimal sensitivity and specificity relative to the CES-D and DT.
The distress screener shows strong psychometric properties and can be considered a valuable community-based instrument to screen for psychological distress related to social, emotional, physical, and other patient-related symptoms and problems. This study is the first to address the chasm between hospital and community-based screening by validating a community-based instrument and has begun to demonstrate the feasibility of screening in the community.
本研究旨在检验一种 36 项基于社区的问题相关困扰筛查工具的心理测量学特性，该工具在癌症支持社区的 14 个分支机构招募的 319 名癌症幸存者中进行了测试。
采用 Cronbach's alpha 系数评估内部信度。采用组内相关系数（ICC）评估重测信度。通过与癌症治疗功能评估一般健康状况量表（FACT-G）、流行病学研究中心抑郁量表（CES-D）和困扰温度计（DT）的相关性，以及使用 CES-D（≥16）和 DT（≥4）作为标准的接收器操作特性（ROC）曲线分析，来确定同时效度。采用非参数方差分析来确定判别效度。
困扰筛查器具有较高的内部一致性（Cronbach's alpha = 0.91）和较强的重测信度（ICC≥0.75）。困扰筛查器的总分与 FACT-G（R²=0.58，p<0.001）、CES-D（R²=0.48，p<0.001）和 DT（R²=0.35，p<0.001）高度相关，表明具有较强的同时效度，能够区分具有临床意义的组别。ROC 分析显示，对于评定为≥3 的问题项目，8 分为最佳截断值，相对于 CES-D 和 DT，具有最佳的灵敏度和特异性。
困扰筛查器具有较强的心理测量学特性，可作为一种有价值的社区工具，用于筛查与社会、情感、身体和其他与患者相关的症状和问题相关的心理困扰。本研究首次通过验证一种基于社区的工具来解决医院和社区筛查之间的差距，并已开始证明在社区中进行筛查的可行性。
