Distress Thermometer, require nothing more than paper and pencil. Most are administered by patients themselves. Although some must be purchased commercially and require a licensing agreement and fee, others are available at no cost.

Screening tools In addition to having strong predictive value,5 effective screening tools should be brief and feasible for routine use in various clinical settings. Such tools are available for screening patient populations and identifying individuals with some types of psychosocial health care needs. For example, a number of screening tools for detecting mental health problems, such as anxiety, depression, adjustment disorders, or post-traumatic stress disorder (PTSD) or post-traumatic stress syndrome (PTSS), have been tested with cancer survivors in different oncology settings and found to meet these criteria. The Brief Symptom Inventory (BSI)©-18, for example, measures depression, anxiety, and overall psychological distress level in approximately 4 minutes (Derogatis, 2006). Its reliability, validity, sensitivity, and specificity have been documented in tests involving more than 1,500 cancer patients with more than 35 different cancer diagnoses (Zabora et al., 2001), as well as adult survivors of childhood cancer (Recklitis et al., 2006). The Hospital Anxiety and Depression Scale (HADS) also is useful in screening individuals with cancer or other illnesses for psychological distress because its 14-item, self-report questionnaire omits measures of fatigue, pain, or other somatic expressions of psychological distress that could instead be symptoms of physical illness and confound the interpretation of screening results (Zigmond and Snaith, 1983). Other useful psychological screening tools include, for example, the Brief Zung Self-Rating Depression Scale; Rotterdam Symptom Checklist; Beck Depression Inventory-Short Form (Trask, 2004); PTSD Checklist-Civilian Version (Andrykowski et al., 1998); Patient Health Questionnaire (PHQ), SF (Short Form)-8; 4-item Primary Care PTSD Screen (Hegel et al., 2006); and PHQ-9 (Lowe et al., 2004).

However, in addition to unresolved questions about the appropriate use and interpretation of the results obtained with these psychological screening tools (Trask, 2004; Mitchell and Coyne, 2007), their varying foci necessitate either administering multiple tools—infeasible for most clinical


Screening instruments are never 100 percent accurate and should be distinguished from diagnostic tools and processes. All screening instruments detect false positives (people without the condition whom the instrument falsely identifies as having the condition) and the converse (false negatives). Consequently, a measure of all screening tools is their predictive value—how accurately they identify those who actually have the condition(s) of interest (the instrument’s sensitivity) and identify those who do not (the instrument’s specificity).

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