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This is an academic presentation from June 2008, IPOS (Psycho-oncology) Conference, Madrid re the new screening tool "Emotion Thermometers". It is primarily intended for clinicians and researchers working in this field. The main question addressed is how good is the ET tool in screening for depression and anxiety after cancer.
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Alex Mitchell Leicester Royal Infirmary
Elena Baker-Glenn University of Nottingham
Paul Symonds Leicester Royal Infirmary
June 2008June 2008
Screening using the Emotion Thermometer tool
A useful extension to the distress thermometer?
1. Purpose of Screening?1. Purpose of Screening?
PHQ9 Linear distribution
0
5
10
15
20
25
30
35
Zero One Two
Three
Four
Five Six
Seven
Eight
Nine
TenElev
enTwelveThir
teen
Fourte
enFifte
enSixt
een
Sevente
enEigh
teen
PHQ9 (Major Depression)PHQ9 (Minor Depression)PHQ9 (Non-Depressed)
Baker-Glen, Mitchell et al (2008)
Depression
13%
20%
57%
48%
38%
18%
Anxiety
Distress/Adjustment Disorder
Rate of anxiety 18% from StarkDistress 57% from Ransom DT
- Please circle the number (0-10) that best describes how much distress you have been experiencing in the past week, including today.
- What phone number would you like us to contact you on if necessary?
Please tick WHICH of the following is a cause of distress:
DiarrhoeaAnger
ConstipationWorry
IndigestionSadness
EatingNervousness
Is there anything important you would like to add to the list?__________________________________________________________________________________________
Mouth soresFears
BreathingDepression
Bathing/ DressingEmotional Problems
Getting around
Hot flushesSleepDealing with children
SexualFatigueDealing with partner
Feeling swollenNauseaFamily Problems
Metallic taste in mouthPain
Tingling in hands/ feetPhysical problemsWork/School
Nose dry/ congestedTransport
Skin dry/ itchyLoss of meaning or purpose in lifeMoney
FeversRelating to GodHousing
Changes in UrinationLoss of faithChildcare
Physical Problems contd…Spiritual/ Religious ConcernsPractical Problems
The distress thermometerThe distress thermometer
=> Validity
Distribution of DT ScoresRansom (2006) PO (n=491)
13.814.7
15.7
13.2
10.4
8.47.7 7.3
3.7 3.3
1.8
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Score 0 Score 1 Score 2 Score 3 Score 4 Score 5 Score 6 Score 7 Score 8 Score 9 Score 10
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9% Other/Uncertain
2%
Use a QQ15%
ICD10/DSMIV13%
Clinical Skills Alone55%
1,2 or 3 Simple QQ15%
Cancer Staff Psychiatrists
Mitchell, Kaar, Poster APA 2007Current Method
1,2 or 3 Simple QQ24%
Clinical Skills Alone20%
ICD10/DSMIV24%
Short QQ24%
Long QQ8%
Algorithm26%
Short QQ23%
ICD10/DSMIV0%
Clinical Skills Alone17%
1,2 or 3 Simple QQ34%
Cancer Staff Psychiatrists
Mitchell, Kaar, Poster APA 2007Ideal Method
Effective?
2. Can We Rely on the DT Alone2. Can We Rely on the DT Alone
DepT & Major DepressionDepT & Major Depression
21719324
20218814Test -ve
15510Test +ve
DepressionABSENT
DepressionPRESENT
Sensitivity42%
PPV 67%
Specificity97%
NPV 93%
Prevalence 11%
DT 28%
DT79%
DT67%
DT 95%
Ultra-short Tests & DepressionUltra-short Tests & Depression
36033816787
27952643152Test -ve
18081173635Test +ve
DepressionABSENT
DepressionPRESENT
Sensitivity81%
PPV 32%
Specificity69%
NPV 93%
Prevalence 18%
N=17 studies 3603
DT 28%
DT 95%
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
1 - Specificity
Sens
itivi
tyPHQ2 Two QQ
PHQ2 Interest
PHQ9
PHQ2 Depression
HADS-D DT (4v5)
DT (3v4)
HADS-T
(3v4)
3. New Methods for 20083. New Methods for 2008
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
DistressThermometer
AnxietyThermometer
DepressionThermometer
AngerThermometer
TenNineEightSevenSixFiveFourThreeTwoOneZero
DT
15%
DT(38%)
AngT(26%)
DepT(30%)
AnxT(65%)
8%
2%
4%
0%
10%
0%
0%
0%
2%
21%
1%
2%
ET vs DT; of 130 patients:ET vs DT; of 130 patients:
37% +ve NCCN on the DT vs 69% on the ET
Of 63% DT low scorers 51% recorded emotional difficulties on the new Emotion Thermometers (ET) tool
Out of those with any emotional complication93.3% would be recognised using the AnxT alone, vs 54.4% who would be recognised using the DT alone.
HADS-A Score & AnxT Score
y = 1.014x + 2.3207R2 = 0.5702
0
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10
HADS-D Score & DeptT Score
y = 0.8165x + 2.7614R2 = 0.3048
0
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10
DT DepTVsHADS-A
AnxT AngT
AUC:DT=0.82DepT=0.84AnxT=0.87AngT=0.685
DT DepTVsHADS-D
AnxT AngT
AUC:DT=0.67DepT=0.75AnxT=0.62AngT=0.69
DepT & Major DepressionDepT & Major Depression
21719324
20218814Test -ve
15510Test +ve
DepressionABSENT
DepressionPRESENT
Sensitivity42%
PPV 67%
Specificity97%
NPV 93%
Prevalence 11%
DT 28%
DT79%
DT67%
DT 95%
4. Extras4. Extras
HADS-A Score & DT Score
y = 0.9117x + 3.9311R2 = 0.4098
0
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10
HADS-D Score & DT Score
y = 0.4334x + 3.3146R2 = 0.11870
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10
Credits & Acknowledgments
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal Infirmary
For more information see www.psycho-oncology.info
For more presentations www.psycho-oncology.info/slides
© Alex J Mitchell 2008
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