Should ultrashort mental health screening tools be used across oncology practices?

是的。

证据始终显示，癌症患者的痛苦风险增加，这可能会对他们的健康相关生活质量产生不利影响，并在整体患者生存中发挥作用。然而，尽管有证据表明，肿瘤学临床医生缺乏时间和渴望简短的社会心理评估，而不是冗长的临床评估访谈，肿瘤学临床医生仍未认识到社会心理困扰。

Therefore, the use of ultrashort screening tools may be considered by busy oncology practices and clinicians as an easy, inexpensive systematic screening approach for routine distress assessment.

Several ultrashort screening measures have been introduced, validated and implemented by the cancer community. For example, the Distress Thermometer (DT) is the most widely utilized and investigated single-item psychological screening measure developed specifically for patients with cancer and survivors. The PHQ-2, a two-item depression screen utilized in the primary care setting, also has been used among cancer populations.

Introduced more recently, the Patient-Reported Outcomes Measurement Information System (PROMIS) measures priority symptom burdens and outcomes in individuals with various chronic health conditions, including cancer, using existing self-report measures and online computer-adaptive testing.

然而，超时筛查工具的诊断准确性可检测大多数需要在癌症轨迹不同点需要心理社会支持的患者的困扰。而且，很少有研究将这些措施的准确性与精神病评估研究中常规使用的标准诊断访谈进行比较。这种调查形式至关重要，因为如果没有这样的比较，确定超短工具的准确性程度可能会具有挑战性。

例如,米切尔和他的同事们进行了rigorous systematic literature search and identified 38 analyses, 19 of which evaluated the DT, to examine the diagnostic validity of ultrashort screening in cancer settings. The pooled analysis revealed ultrashort methods were sensitive at excluding possible cases of depression but inadequately confirmed a suspected diagnosis. This review was the first to confirm that ultrashort screening measures should not be utilized alone to diagnose depression, anxiety or distress in patients with cancer but, rather, should be considered as a preliminary screener.

Low and colleagues evaluated the two-question depression screen, reporting a sensitivity between 84% and 94% and specificity between 72% and 73% compared with two criterion measures, supporting its usefulness as a screening tool for psychological distress in busy clinical U.K. cancer settings. Yet, the low positive predictive values revealed that high test scores require psychological referral for a comprehensive assessment.

在另一项研究中，Recklitis及其同事将Promis抑郁症短形式（Promis-D-SF）与年轻成人癌症幸存者的结构化诊断访谈（SCID）进行了比较。Promis-D-SF表现出与SCID测量的抑郁诊断和症状相对强的一致性。但是，截止分数不符合临床筛查的标准。作者得出的结论是，Promis-D-SF可能有助于评估抑郁症，但作为单个筛查仪器的效用有限。

总而言之，在诊断和治疗阶段早期，应仅用超短质量的高质量心理健康问卷来检测困扰，抑郁和焦虑，并在整个癌症轨迹中反复给药。Ultrashort工具可以用作初步的“危险信号”，以提示转介以进行其他全面的心理评估，但是它们绝不应作为替代或替代综合标准标准心理健康诊断临床访谈。

It remains critical that the cancer organization and clinicians collaborate to implement routine distress screening and management tailored for their clinical environment to provide equitable quality care. It is also vital that oncology clinicians undergo rigorous training in use of these tools for proper symptom detection to ensure that any patient distress detected is appropriately addressed.

References:

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Batty GD等。BMJ。2017;doi:10.1136/bmj.j108.

Carlson LE, et al.J Clin Oncol。2012;doi:10.1200/JCO.2011.39.5509.

Donovan KA, et al.Psychooncology。2014;doi:10.1002/pon.3430.

Jacobsen PB.J Clin Oncol。2007; doi：10.1200/jco.2007.13.1367。

Low J, et al.J疼痛症状管理。2009; doi：10.1016/j.jpainsymman.2008.08.006。

Mitchell AJ.J Clin Oncol。2007; doi：10.1200/jco.2006.10.0438。

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Recklitis CJ, et al.Cancer。2020;doi:10.1002/cncr.32689.

Riley WT, et al.j ntim health政策经济。2011; 14（4）：201–208。

Skarstein J, et al.J Psychosom Res。2000; doi：10.1016/s0022-3999（00）00080-5。

Vodermaier A, et al.J Natl Cancer Inst。2009;doi:10.1093/jnci/djp336.

Fay Hlubocky，博士，马萨诸塞州，is a clinical health psychologist and research ethicist at University of Chicago Medicine. She can be reached atfhlubock@medicine.bsd.uchicago.edu。

不。

Ultrashort筛选方法具有功能，但是工具非常有限，需要补充。

This form of screening may tell us that a patient is anxious or depressed, which are psychological problems, but they do not suggest interventions or offer solutions. Moreover, some people naturally have anxious personalities, whereas others tend to have lower moods. But, these personality traits are almost never the primary issue that a patient with cancer needs to have addressed.

The low uptake of ultrashort screening likely is due to its limited function. For example, it can identify patients who are stressed, who may be anxious or who may be depressed. But, these emotional states are such a small part of the overall patient story. The bigger story is how patients are coping with these feelings and if they need help.

问题不是：患者或其家人有什么问题？相反，真正的问题应该是：对患者及其家人重要的是什么？后者是重点应居住的地方以及应花费能量的地方。人格特质很难影响。教授应对技巧更有效。

如果我们使用的是超短方法，那么我们就不太可能对患者的社会状况有真正的认识，这是大多数压力的产生的地方。焦虑和抑郁确实重要，但是使用超短方法就像在月球上贴上旗帜然后离开。如果我们有一种筛查工具，该工具不激励，教育或帮助患者确定对他们重要的事情以及对他们护理的障碍，那么我们真正在做什么？仅筛选就无能为力。我们不需要更快的筛选；患者需要更深入的筛查才能解决问题的根源。我们需要联系，激励，教育和帮助患者及其家人。

当我们询问抑郁症，焦虑，财务问题，疲劳或痛苦时，我们需要以使患者能够理解环境并知道帮助他们可以使用的方式的方式提出问题。提出问题的道德论点很难，但没有采取任何措施来解决患者面临的困难。

In summary, the screening process should be a therapeutic process. Ultrashort instruments cannot do this. More advanced and comprehensive screening tools ask more questions, and they gather more useful information in a way that promotes action and instills hope.

Matthew Loscalzo，LCSW，is executive director of the department of supportive care medicine at City of Hope. He can be reached atmloscalzo@coh.org。