Can an Adapted Distress Thermometer in the Pediatric Population Be Valid and Clinically Meaningful?

• Published in: Psycho-oncology (Chichester, England) Vol. 21; p. 27
• Main Authors: Wiener, L, Zadeh, S, Battles, H, Pao, M
• Format: Journal Article
• Language: English
• Published: Chichester Wiley Subscription Services, Inc 01.02.2012
• Subjects: Childrens health; Emotional disorders; Oncology; Pediatrics; Thermometers
• ISSN: 1057-9249; 1099-1611

To present a brief background of the development of an adapted distress thermometer for an outpatient pediatric setting along with preliminary validity data. Differences between children, adolescents and young adults distress ratings were also examined. Lessons learned and key elements that cause pediatric patients to be most distressed will be presented along with recommendations for screening to be clinically meaningful. Youth between the ages of 7-21 enrolled in an NIH clinical trial for the treatment of cancer, NF1, HIV or a primary immune deficiency and their parents were offered enrollment in a cross sectional study designed to validate an adapted distress thermometer for use in an outpatient setting. Interviews were conducted concurrently, and separately. Interviews were completed with 150 child-parent pairs. Distress ratings were significantly correlated with standardized measures of anxiety, depression and pain, but not fatigue. Between 25 and 50% of the cohort endorsed worry, loneliness, boredom, irritability, sadness and anger as symptoms that cause them distress. Physical symptoms reported as most stressful were pain, fatigue and difficulty sleeping. School, dealing with family issues, siblings and old friends were also frequently endorsed as causing distress. Differences in distress symptoms between the 13-17 and over 18 year old cohorts were found and will be reported. An adapted distress thermometer appears to be a sensitive and viable option for rapid distress screening in a pediatric outpatient setting. It is a means to both quickly identify those who should be evaluated further and to link self-reported symptoms to appropriate psychosocial services. Future research is needed to more specifically evaluate whether the numeric rating given by youth has clinical relevance to outcomes, services used or to meaningful differences in the emotional, physical or social symptom checklist arenas. Findings from this study will help guide best practices for implementation of routine distress screening in the pediatric outpatient cohort. This work is supported in part by the Intramural Research Programs of the National Institutes of Health, National Cancer Institute, Center for Cancer Research, the National Institutes of Mental Health and the NIH Clinical Center.