Ingram School of Nursing, McGill University, Wilson Hall, 3506 Sherbrooke Street, Montreal, H3A 2A7, Canada,
Qual Life Res. 2014 Oct;23(8):2257-65. doi: 10.1007/s11136-014-0673-0. Epub 2014 Apr 1.
The distress thermometer (DT) is commonly used in cancer care to improve detection of distress. The DT's recommended cut-off score of 4 or 5 has typically been established using the Hospital Anxiety and Depression Scale (HADS) by receiver operating characteristic curve analysis. The present analysis complements these studies by critically examining the use of the HADS to identify the DT's cut-off score and corroborating the DT's cut-off scores using item response theory (Rasch analysis).
The DT and HADS were completed by 340 patients with cancer. Rasch dimensionality analysis was performed on the HADS-Total, and test characteristic curves were examined to equate the DT and the HADS subscales. Identified DT cut-off scores were then examined for their sensitivity and specificity.
Rasch analysis did not support the unidimensionality of HADS-Total. The test characteristic curves indicated that a cut-off score of ≥8 on the HADS-Anxiety and HADS-Depression subscales was equivalent to a score of 6 and 7 on the DT, respectively. However, a DT cut-off score of 5 resulted in the best balance between sensitivity and specificity across the HADS-Anxiety and HADS-Depression subscales.
Despite being a popular practice, the present findings did not support combining the HADS-Anxiety and HADS-Depression subscales to identify the DT's cut-off score. Furthermore, these results inform the use of the DT as a preliminary screening tool and suggest that when a single screen is used, a DT cut-off score of 6 or 7 might be more appropriate than the typical cut-off score of 4.
在癌症护理中，常用苦恼温度计（DT）来提高苦恼的检出率。DT 的推荐截断分数通常为 4 或 5，这是通过接收者操作特性曲线分析，使用医院焦虑和抑郁量表（HADS）建立的。本分析通过使用项目反应理论（Rasch 分析）对 HADS 进行批判性检查，以确定 DT 的截断分数，并对 DT 的截断分数进行佐证，从而补充了这些研究。
340 名癌症患者完成了 DT 和 HADS。对 HADS 总分进行了 Rasch 维度分析，并检查了测试特征曲线，以将 DT 和 HADS 分量表进行匹配。然后，对确定的 DT 截断分数进行了敏感性和特异性检验。
Rasch 分析不支持 HADS 总分的单维性。测试特征曲线表明，HADS 焦虑和 HADS 抑郁分量表的截断分数≥8 分别相当于 DT 的 6 和 7。然而，DT 的截断分数为 5 在 HADS 焦虑和 HADS 抑郁分量表中，在敏感性和特异性之间取得了最佳平衡。
尽管这是一种常见的做法，但本研究结果并不支持将 HADS 焦虑和 HADS 抑郁分量表合并，以确定 DT 的截断分数。此外，这些结果为 DT 作为初步筛查工具的使用提供了信息，并表明当使用单一屏幕时，DT 的截断分数为 6 或 7 可能比典型的截断分数 4 更合适。
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