Die deutsche Version des NCCN Distress-Thermometers
Empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten
Abstract
Zusammenfassung: Das NCCN Distress-Thermometer ist ein vom National Comprehensive Cancer Network (NCCN) entwickeltes Screeninginstrument zur Erfassung psychosozialer Belastungen bei onkologischen Patienten. Es besteht aus einer Skala von 0 bis 10 und einer Problemliste als Überweisungsschema zu entsprechenden professionellen Diensten. International wird ein Cut-off-Wert von 5 als Signal empfohlen, dass ein Patient auffällig belastet ist und Unterstützung benötigt. Die deutsche Adaptation erfolgte an einer Stichprobe von n = 475 Krebspatienten in der onkologischen Rehabilitation. Zur Validierung wurde die Hospital Anxiety and Depression Scale (HADS-D) und die Kurzform des Fragebogens zur Progredienzangst (PA-F 12) eingesetzt. Die Diskriminationsfähigkeit des Distress-Thermometers ist besonders zur Identifikation einer hohen Belastung (HADS Cut-off > 11) mit AUC-Werten von 0.71 bis 0.76 gut. Bei einem Cut-off-Wert von 5 im Distress-Thermometer zeigen sich bei moderater Belastung in den Merkmalen Angst und/oder Depressivität (HADS Cut-off > 8) eine Sensitivität bis 84 % und eine deutlich niedrigere Spezifität von bis zu 47 %. Bei einem HADS Cut-off > 11 und einem Cut-off-Wert von 5 im Distress-Thermometer liegen die Sensitivitätswerte bei bis zu 97 % und die Spezifitätswerte bei 41 %. Die Spezifität des Instruments ist in der deutschen Stichprobe niedriger als die in internationalen Studien gefundenen Werte, die Sensitivität ist entsprechend höher. Das NCCN Distress-Thermometer stellt aufgrund seiner hohen Akzeptanz, seiner Kürze und guten Praktikabilität im klinischen Alltag ein Screeninginstrument dar, das für den weiteren Einsatz in der onkologischen Versorgung empfohlen werden kann.
Abstract: The NCCN Distress-Thermometer is a brief screening tool for cancer patients to assess distress. It has been developed by the National Comprehensive Cancer Network (NCCN) in the US. It consists of a scale from 0-10 and a problem list which provides information to which health care professionals a patient should be referred. A score of 5 is internationally recommended as an indicator that a patient is distressed and needs support. For the German adaptation, a sample of n = 475 cancer patients was assessed during oncological rehabilitation. To validate the screening tool, we used the Hospital Anxiety and Depression Scale (HADS-D) and the brief version of the Fear of Progression Questionnaire (PA-F 12). The discriminating power of the Distress-Thermometer was particularly good when screening for higher levels of anxiety or/and depression (HADS Cut-off > 11): AUC from 0.71 to 0.76. For a score of 5 in the Distress-Thermometer, we found a sensitivity up to 84 % and a lower specifity up to 47 % when screening for moderate levels of anxiety or/and depression (HADS Cut-off > 8). Screening for a higher level of distress (HADS Cut-off > 11), we found a sensitivity up to 97 % and a specifity up to 41 % when using a score of 5 in the Distress-Thermometer. The specifity of the instrument is lower as the values for specifity found in international studies, but the sensitivity is little higher in the German sample. Due to its high acceptance, its brevity and practice orientation, the NCCN Distress-Thermometer can be recommended as a screening tool to assess psychosocial distress in cancer patients.
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