The Distress Thermometer: Cutoff Points and Clinical Use.
Alexandra Cutillo, Erin O'Hea, Sharina Person and 3 others
PMID 29493167WHAT IT FOUND
In cancer patients, a Distress Thermometer score of 3 detected more distress than the standard cutoff of 4, though it also flagged more false positives.
Scores were highest in the 1-4 weeks after diagnosis, before treatment begins.
Key findings
01A Distress Thermometer cutoff of 3 had higher sensitivity (0.78) than the current recommended cutoff of 4 (0.68), but lower specificity (0.69 vs 0.79).
02Patients diagnosed 1-4 weeks prior reported significantly higher distress than those diagnosed 1-6 months or more than 6 months prior.
03Distress Thermometer scores correlated significantly with the Behavioral Health Status index, with mean scores rising from 0.79 in low distress to 4.78 in clinically elevated distress.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was largely female (86% of enrolled participants were female) and White (92%), with nearly half having breast cancer, limiting generalizability to other demographics. The Behavioral Health Status scale was used as the reference standard, which is not a clinical diagnosis, so the results reflect correlation with self-reported symptoms rather than confirmed psychiatric conditions. More than half the participants were cancer survivors, which may have influenced baseline distress levels compared to those in active treatment.
Declared interests
The study was funded by the NIH. No other conflicts of interest were reported in the provided text.
The easy way to misread this
Do not interpret the higher sensitivity of a DT cutoff of 3 as a reason to lower the threshold for all patients without considering resources. This cutoff increases false positives, meaning more patients will be flagged who are not actually distressed, potentially straining psychosocial services.