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 Emotion Thermometers Tool ©

    A rapid screening tool for emotional disorders in clinical practice

Background

In 1998 the Distress Thermometer (DT) was developed and validated for evaluation of distress (and anxiety and depression) in cancer [Roth et al, 1998]. It was adopted into recommendations by the US National Comprehensive Cancer Network. The DT is a simple, self-report, pencil and paper measure consisting of a line with a 0-10 scale anchored at the zero point with ‘No Distress’ and at scale point ten with ‘Extreme Distress’. Patients are given the instruction “How distressed have you been during the past week on a scale of 0 to 10?” The recommended cut-off was 4v5, but in 2007 was revised to 3v4. In a comprehensive review of the accuracy of the DT, it was found to have a sensitivity of 80.9% and a specificity of 60.2%, (positive predictive value (PPV) of 32.8 and negative predictive value (NPV) of 92.9%) for depression, a sensitivity of 77.3% and specificity 56.6% (PPV of 55.2% and NPV of 80.25%) for anxiety it and a sensitivity of 77.1% and specificity 66.1% (PPV 55.6% and NPV 84.0%) for broadly defined distress [Mitchell, 2007]

In 2007 we piloted and validated an extension of the DT called the Emotion Thermometers Tool. This is a new five dimensional tool retaining the convenience of the innovative DT but with superior accuracy. It comprises five visual analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help). Each domain is rated on an 11 point (0 to 10) Likert scale in a visual thermometer, namely the Distress Thermometer (DT), Depression Thermometer (DepT), Anxiety Thermometer (AnxT) and Anger Thermometer (AngT). In a pilot evaluation in the Leicester Cancer Centre (UK), we found that the tool takes about 45 seconds (compared to about 20 seconds for the DT) for most patients for complete and is no less acceptable than the DT alone.

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Validation (full papers published in Psycho-oncology 2009 Mar 18 - Epub ahead of print)

In our study in the Leicester Cancer Centre, 11.5% of people scored three or below on all ET domains and 69.3% scored four or above on at least one domain. Of low scorers on the DT about 50% recorded emotional difficulties on the new Emotion Thermometers (ET) tool, suggesting added value beyond the Distress thermometer (DT) alone.

Using a cut-off of 3v4 on all thermometers against the total HADS score (cut-off 14v15), the optimal thermometer was the AngT (sensitivity 89% specificity 46%). Against HADS Anxiety scale (cut-off 7v8), and judging by the Predictive Summary Index, the optimal thermometer was AnxT (sensitivity 92% specificity 61%). Against the HADS depression scale, the optimal thermometer was the depression thermometer (sensitivity 60% specificity 78%). Finally, against the DSM-IV diagnosis of major depression the optimal thermometer was the depression thermometer sensitivity 80% specificity 79%) but no single method had good positive predictive value (PPV). Further improvements can be made by adjusting the cut-offs particularly for detection of anxiety (AnxT ROC = 0.867 at a cut-off of 5v6) and detection of depression (DepT ROC = 0.751 at a cut-off 4v5).

New data will be presented in IPOS2010!

Copyright

The tool is subject to copyright (c) Alex J Mitchell but freely available (royalty free) for non-commercial and clinical use.

If this (or related) tools are useful please consider donating to help with our research

Future Developments

We are currently working on a revision of the ET tool (the ET7) which adds the domains of disease duration and burden. The ET7 has been validated in neurological settings and planned for cancer in 2010.

We welcome collaborations with other groups who are interested in using the ET for research.

References

Roth AJ, Kornblith AB, Batel-Copel L, et al. Rapid screening for psychologic distress in men with prostate carcinoma: a pilot study. Cancer 82:1904 –1908, 1998

NCCN Clinical Practice Guidelines in Oncology™ Distress  Management V.1.2007 http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf (accessed 25 March 2007)