ipos08 - screening using the emotion thermometers - a useful extension to the distress thermometer?...

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Alex Mitchell Leicester Royal Infirmary Elena Baker-Glenn University of Nottingham Paul Symonds Leicester Royal Infirmary June 2008 June 2008 Screening using the Emotion Thermometer tool A useful extension to the distress thermometer?

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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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Page 1: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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?

Page 2: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

1. Purpose of Screening?1. Purpose of Screening?

Page 3: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]
Page 4: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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)

Page 5: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

Depression

13%

20%

57%

48%

38%

18%

Anxiety

Distress/Adjustment Disorder

Rate of anxiety 18% from StarkDistress 57% from Ransom DT

Page 6: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

- 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

Page 7: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 8: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 9: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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?

Page 10: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

2. Can We Rely on the DT Alone2. Can We Rely on the DT Alone

Page 11: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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%

Page 12: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]
Page 13: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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%

Page 14: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 15: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

(3v4)

Page 16: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

3. New Methods for 20083. New Methods for 2008

Page 17: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]
Page 18: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 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

Page 19: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

DT

15%

DT(38%)

AngT(26%)

DepT(30%)

AnxT(65%)

8%

2%

4%

0%

10%

0%

0%

0%

2%

21%

1%

2%

Page 20: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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.

Page 21: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 22: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 23: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

DT DepTVsHADS-A

AnxT AngT

AUC:DT=0.82DepT=0.84AnxT=0.87AngT=0.685

Page 24: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

DT DepTVsHADS-D

AnxT AngT

AUC:DT=0.67DepT=0.75AnxT=0.62AngT=0.69

Page 25: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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%

Page 26: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]
Page 27: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

4. Extras4. Extras

Page 28: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 29: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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

Page 30: IPOS08 - Screening Using The Emotion Thermometers - A Useful Extension To The Distress Thermometer? [June 2008]

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