Wiener Lori, Battles Haven, Zadeh Sima, Widemann Brigitte C, Pao Maryland
National Cancer Institute, Pediatric Oncology Branch, Bethesda, MD, USA.
National Institute of Mental Health, Bethesda, MD, USA.
Psychooncology. 2017 Apr;26(4):461-468. doi: 10.1002/pon.4038. Epub 2015 Nov 30.
Psychosocial distress is under-recognized in children with cancer and other serious medical illnesses because of a focus on pressing medical concerns.
This study assessed the validity, inter-rater reliability, sensitivity/specificity, acceptability, and feasibility of administration of a pediatric distress thermometer (DT) designed to screen for the presence of psychosocial distress in youth with serious medical illnesses.
MATERIALS & METHODS: Two hundred eighty-one patient-caregiver-provider triads were enrolled from two hospital outpatient clinics. Patients diagnosed with cancer and other life-threatening diseases, caregivers, and providers completed the DT and a DT acceptability rating. Patients and caregivers completed standardized measures of anxiety, depression, pain, and fatigue. Providers completed a measure of disease severity. Data collectors completed a feasibility rating.
The DT was significantly correlated with both caregiver and patient reports of depression, anxiety, pain, and fatigue, exhibiting concurrent validity. Parent, child, and caregiver report demonstrated significant, moderate inter-rater reliability, with lower concordance between raters in the youngest age group. The DT is a sensitive instrument for screening of psychosocial distress when compared with the selected gold standard (Brief Symptom Inventory 18 depression subscale and the Children's Depression Inventory). The DT is not highly specific but quickly identifies those in need of further psychosocial assessment.
Screening, using an adapted pediatric DT, is valid, feasible, and acceptable to patients, caregivers, and medical providers across chronic medical illnesses.
As patient and caregiver reports are not always concordant, both patient and caregiver report of distress are important for the provider to obtain clinically meaningful information to guide interventions. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
由于关注紧迫的医疗问题，癌症患儿和患有其他严重疾病的儿童的心理社会困扰未得到充分认识。
本研究评估了一种儿科困扰温度计（DT）用于筛查患有严重疾病的青少年心理社会困扰的有效性、评分者间信度、敏感性/特异性、可接受性和实施可行性。
从两家医院门诊招募了281个患者 - 照顾者 - 提供者三元组。被诊断患有癌症和其他危及生命疾病的患者、照顾者和提供者完成了DT及DT可接受性评分。患者和照顾者完成了焦虑、抑郁、疼痛和疲劳的标准化测量。提供者完成了疾病严重程度的测量。数据收集者完成了可行性评分。
DT与照顾者和患者关于抑郁、焦虑、疼痛和疲劳的报告显著相关，显示出同时效度。家长、儿童和照顾者的报告显示出显著的、中等程度的评分者间信度，最年幼年龄组的评分者之间一致性较低。与选定的金标准（简明症状量表18抑郁分量表和儿童抑郁量表）相比，DT是一种筛查心理社会困扰的敏感工具。DT特异性不高，但能快速识别那些需要进一步进行心理社会评估的人。
使用改良的儿科DT进行筛查对患有慢性疾病的患者、照顾者和医疗提供者来说是有效、可行且可接受的。
由于患者和照顾者的报告并不总是一致的，患者和照顾者关于困扰的报告对于提供者获取有临床意义的信息以指导干预都很重要。2015年发表。本文是美国政府作品，在美国属于公共领域。
