Hornheide Screening Instrument Research Articles

Assessment and Evaluation of Psychosocial Distress in Outpatients with Cancer at a University Hospital in Germany

Introduction: Cancer patients (pts) suffer from a significant amount of psychosocial distress related to tumor disease itself or straining treatments. Despite recommendations on how to screen for and to deal with psychosocial distress in cancer pts, data about implementation of psycho-oncological interventions (poi) in outpatient settings of cancer pts are scarce. The aim of this study was to identify outpatients with cancer in need of poi and to evaluate different assessment instruments. Methods: N = 200 outpatients with hemat-/oncological malignancies were interviewed between October 2015 and December 2017 at the University Hospital Mannheim using the Basic Documentation for Psycho-Oncology (PO-Bado) and the Hornheider Screening Instrument (HSI) – both clinician-administered assessment tools – followed by descriptive, univariate, and agreement analysis. Results: N = 61 cancer pts (31%) were identified to be in need for poi considering the results of both questionnaires. The number of identified pts in need of poi was lower when analyzing the results of the PO-Bado (n = 42, 21%) and the HSI (n = 39, 20%) separately. The degree of agreement between the results of PO-Bado and HSI was low (kappa = 0.3655). Several factors like gender, age and diagnosis were identified to have significant impact on the need for poi (p ≤ 0.05). Conclusion: Our study underlines that different screening instruments for psychosocial distress may identify disparate populations of cancer pts. The study data also revealed significant characteristics that might be associated with elevated levels of psychosocial distress and a clear indication for poi. However, further analyses on larger populations of cancer pts are needed to provide information how to transfer positive screening to poi in clinical routine.

Resilience as a Factor Influencing Psychological Distress Experience in Patients with Neuro-Oncological Disease

Cancer causes psychological distress. Approximately one-third of all patients with cancer suffer from distress requiring psycho-oncological treatment. Examining factors contributing to their distress can inform approaches to counteracting them. Among such factors, resilience is considered to be a psychological adaptive capacity resulting from complex genetic, epigenetic, psychological, and environmental influences. For that reason, we investigated resilience as a factor of psychological distress experience among patients with neuro-oncological disease. To assess distress among patients with neuro-oncological diseases, we performed electronic psycho-oncological screening in the Department of Neurosurgery at Tübingen University Hospital (n = 100) following tumor surgery (T0) using the Resilience Scale 13, the Hornheider Screening Instrument, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder Scale-2, and the Distress Thermometer, all administered on tablets. Follow-up was done 6 months after (T1). The distress of patients with neuro-oncological disease decreased significantly after 6 months (p < 0.01). Most patients (87%) showed moderate to high resilience. Although significant correlations with distress are measurable at the T0 time point (ρ = -0.318 **, p < 0.01), no significant correlations were observed at T1. Thus, resilience seems to significantly impact distress in the acute phase of the neuro-oncological disease. For clinical practice, our findings suggest that resilience-focused screening can provide useful information about patients at risk of experiencing distress.

Validation of the psychometric properties of a "Modified Version of the Hornheider Screening Instrument" (HSI-MV) using a sample of outpatient and inpatient skin tumor patients.

The basis for adequate psycho-oncological care is the identification of patients with psychosocial support needs. The German Working Group for Psychooncology also recommends the Hornheider Screening Instrument (HSI) for this purpose. The question, "Is anyone in your family particularly burdened by the hospital stay?" is intended to capture disease-related family stress. But is this item equally suitable for outpatients and inpatients? The study objective was to examine how replacing the original item affects the test performance of this modified version of the HSI and the frequency of psychosocial stress. 92 outpatients and 98 inpatients with skin tumors assessed their psychosocial situation using different questionnaires. Compared to inpatients, less than half as many outpatients answered the item in the affirmative. If the question was replaced by: "Is someone in your family particularly burdened by your disease or the course of the disease?" this setting-related difference did not arise. The "Alternative item" and the "Modified version of the HIS" (HSI-MV) proved to be superior to the original item and the original HSI with regard to all examined criteria. The HSI-MV can be used as a reliable and valid instrument for the systematic assessment of psychosocial care needs in outpatient and inpatient settings. Depending on care capacity, a threshold of ≥5 or ≥4 is appropriate. In addition to screening, the desire for support should be enquired.

Psychological Distress of Metastatic Melanoma Patients during Treatment with Immune Checkpoint Inhibitors: Results of a Prospective Study.

Simple SummaryA large proportion of patients with metastatic melanoma suffer from psychological distress. Early identification of these patients is important to be able to offer them adequate support. This longitudinal study aimed to investigate the extent to which the psychological distress of patients with malignant melanoma might change during their first three months of treatment with immune checkpoint inhibitors. We found a high proportion of distressed patients in a cohort of 113 patients at the beginning of immunotherapy, which decreased during therapy. A binary logistic regression analysis provided additional factors indicating an increased risk of developing distress—female gender and occurrence of adverse events correlated significantly with distress values above the threshold. The strongest factor was patients’ self-assessment. When initiating immunotherapy, it is also important to consider the needs of patients and offer them psycho-oncological support.Background: Immune checkpoint inhibitors (ICI) provide effective treatment options for advanced melanoma patients. However, they are associated with high rates of immune-related side effects. There are no data on the distress of melanoma patients during their ICI treatment. We, therefore, conducted a prospective longitudinal study to assess distress and the need for psycho-oncological support in these patients. Methods: Questionnaires were completed before initiation of ICI (T0), after 6–8 weeks (T1), and after 12–14 weeks (T2). We furthermore included the Hornheide Screening Instrument (HSI), distress thermometer (DT), and patients’ self-assessment. Binary logistic regression was performed to identify factors indicating a need for psychooncological support. Results: 36.3%/55.8% (HSI / DT) of the patients were above the threshold, indicating a need for psychooncological support at T0, and 7.8% of the patients reported practical problems. In contrast, at T2, the distress values had decreased to 29.0%/40.2% (HSI/DT), respectively. Female gender and occurrence of side effects significantly correlated to values above the threshold. The strongest factor was the patient’s self-assessment. Conclusion: With the beginning of ICI, psychooncological support should be offered. Furthermore, practical problems should be considered, e.g., transport to therapy. Female patients and patients with side effects should be given special attention, as well as the patient self-assessment.

Psychosocial stress of dermatology inpatients and their relatives - Comparison of patients with and without cancer.

In the clinical treatment pathways of certified oncological centers, psychotherapeutic services are mandatory. Although patients with somatic, non-oncological illnesses show an equally high prevalence of psychosocial stress, these guidelines do not exist for the general hospital sector. Are these patients really less burdened and is psychological support only needed in individual cases? The example of dermatological patients will be used to show whether the need for psychosocial care and the desire for support vary between individuals with and without malignant disease. Using the Hornheider screening instrument and distress thermometer, 216 dermatological inpatients assessed their psychosocial stress and that of a close relative. In addition, they were asked about their desire for support and preferred support provider. i) Patients without skin cancer were more frequently and more severely distressed than cancer patients. ii) Patients of both groups assessed their relatives to be approximately equally distressed. Compared with their own distress, cancer patients assessed their relatives as more frequently and on average more severely distressed. More than 50% of all patients regarded their own disease as the cause of their relatives' distress. iii) The desire for support in both groups was about 18%. iv) Doctors and psychologists were usually named as potential contact persons. The expansion of psychosocial support services for non-tumor patients and their relatives seems necessary. The establishment of appropriate screening methods should be considered. Further studies in other clinical areas are required.

Single-institution cross-sectional study to evaluate need for information and need for referral to psychooncology care in association with depression in brain tumor patients and their family caregivers

BackgroundThe prognosis of patients with brain tumors is widely varying. Psychooncologic need and depression are high among these patients and their family caregivers. However, the need for counselling and need for referral to psychooncology care is often underestimated.MethodsWe performed a single-institution cross-sectional study to evaluate psychooncologic need, depression and information need in both patients and their family caregivers. The Hornheider Screening Instrument (HSI) and the Patient Health Questionnaire (PHQ-9) were used to evaluate psychooncologic need and depression, and a study-specific questionnaire was developed to evaluate information need. Multivariable analyses were performed to detect correlations.ResultsA total of 444 patients and their family caregivers were approached to participate, with a survey completion rate of 35.4%. More than half of the patients and family caregivers were in need for referral to psychooncology care and 31.9% of patients suffered from clinically relevant depression. In multivariable analysis, psychooncologic need were positively associated with mild (odds ratio, OR, 7.077; 95% confidence interval, CI, 2.263–22.137; p = 0.001) or moderate to severe (OR 149.27, 95% CI 26.690–737.20; p < 0.001) depression. Patient information need was associated with depression (OR 3.007, 95% CI 1.175–7.695; p = 0.022).ConclusionsUnmet counselling need in brain tumor patients and their family caregivers associate to high psychooncologic need and depression. Adequate information may decrease the need for referral to psychooncology care and treatment of depression in these patients. Future studies should further explore these relations to promote development of supportive structures.

The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates

The need for psychosocial support and patients' desire for psychosocial support in female cancer patients - predictors and correlates Objectives: The aims of the present study were to determine the need for psychosocial support of cancer patients, the subjective request for support and to examine the relationship between the need for psychosocial counselling, psychological distress and quality of life. Methods: 112 patients (consecutive) answered questionnaires about mental stress (GAD-2 and PHQ-2), quality of life (SF-8) as well as the Hornheide Screening Instrument (HSI) during their hospital stay (T1), two weeks (T2) and three months after their discharge (T3). Results: The need for psychosocial support goes down from 65.2 % (T1) to 39.3 % (T3). The psychological distress was in a positive (GAD-2 - HSI T1: r = 0.44, p < 0.01; PHQ-2 - HSI T1: r = 0.54, p < 0.01), the quality of life in a negative relationship to the need for support (SF-8 PCS - HSI T1: r = -0.45, p < 0.01; SF-8 MCS - HSI T1: r = -0.56, p < 0.01). The match between the need for support and the subjective desire to be cared for by psychologists was low (conversation persons not needing support: T1: 17.1 %, T2: 3.8 %, T3: 5.5 %; conversation persons needing support: T1: 13.7 %, T2: 18.4 %, T3: 18.2 %). Conclusions: The divergence between the assessed need for support and the subjective desire for consultations leads to the conclusion that both methods, screening and asking for desire of counseling, should be adopted in combination to provide adequate psychooncological support.

Evaluation of the psychological burden during the early disease trajectory in patients with intracranial tumors by the ultra-brief Patient Health Questionnaire for Depression and Anxiety (PHQ-4).

Depressive symptoms of patients with intracranial tumors need to be assessed adequately. The Patient Health Questionnaire for Depression and Anxiety (PHQ-4) is an ultra-short screening tool consisting of four items, a cutoff of six indicates depressive symptoms. The aim was to assess patients' psychological burden by the PHQ-4 compared with the results of well-established screening instruments. Patients were screened three times after primary diagnosis postoperatively (t1), after 3 (t2) and 6 (t3) months using the PHQ-4, the Hornheide Screening Instrument (HSI), the NCCN Distress Thermometer (DT), and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire with its brain module (EORTC QLQ-C30 + BN20). Demographic, tumor-related data, and Karnofsky Performance Scale (KPS) were analyzed. A cutoff value for PHQ-4 indicating a need for support or increased distress was determined by applying receiver operating characteristic (ROC). The proportion of patients reaching a total score ≥ 6 was n = 32 out of 139 (23%) at t1; at t2, n = 12 out of 117 (10%) scored ≥ 6. At t3, n = 8 out of 96 (8%) scored ≥ 6. At t1, PHQ-4 scores did not differ significantly between gender, age groups, and tumor laterality. A cutoff value of 2.5 was identified to moderately discriminate between patients in or not in distress (sensitivity 76.8%) and between patients wishing further, specific support or not (sensitivity 82.5%). The PHQ4 can be applied in this patient cohort to detect those with relevant psychological comorbidities. The cutoff value should be re-evaluated in a larger cohort as we observed that a cutoff of 6, as recommended previously, may be too high in order to detect affected patients adequately.

Screening for distress in patients with intracranial tumors during the first 6 months after diagnosis using self-reporting instruments and an expert rating scale (the basic documentation for psycho-oncology short form - PO-Bado SF).

ObjectivePsychosocial screening in brain tumor patients is of high importance. We applied The Basic Documentation for Psycho-Oncology Short Form (PO-Bado SF) in primary brain tumor patients and patients with metastasis. The aim was to evaluating consistency between physicians' perception and the results of the patients' self-assessment.Materials and Methods140 patients with first diagnosis of a brain tumor were screened during their hospital stay (t1) using Distress Thermometer (DT) and Hornheide Screening Instrument (HSI), health-related quality of life was assessed by EORTC QLQ-C30 + BN20. After 3 (t2) and 6 months (t3), patients were re-evaluated. Attending neuro-oncologists completed the PO-Bado SF at all three time points (cut-off for being in need for support >8).ResultsAt t1, the mean of the PO-Bado SF total score was 7.71 (SD = 4.08), at t2 8.22 (SD = 5.40) and at t3 7.62 (SD = 5.72).The proportion of patients reaching a total score >8 was at t1: 43%, at t2: 41% and at t3: 47% (t1–3). Discrimination of PO-Bado SF total score, between patients in (DT ≥6) and those not in distress was more sensitive (cut-off 8.5, AUC 0.772, sens. 71.3%, spec. 67.6%) than discrimination compared to the HIS (cut-off 9.5, AUC 0.779, sens. 65.1%, spec. 77.7%). Higher PO-Bado-SF total score correlated with higher DT scores (r = 0.6, p < 0.0001) and lower EORTC GHS scores (r = −0.55, p < 0.0001).ConclusionPhysicians' perception according to PO-Bado SF provides a different measure for psychosocial burden in patients with brain tumors, however does not completely reflect patients' wishes.

Psychosocial Distress in Bladder Cancer Stratified by Gender, Age, Treatment, and Tumour Stage

Objectives: Cancer patients have to cope with anxieties ­concerning their prognosis, potential recurrence/progression, and treatment-associated sequelae. Stress-related psychosocial factors influence survival and disease-related mortality in cancer patients. Despite improvements in diagnosis and treatment, bladder cancer (BC) remains characterized by high rates of recurrence and progression. We screened ­pre-therapeutically the stress level of BC patients stratified by gender, disease state, treatment, and other factors by ­self-administered validated questionnaires to integrate them into psychosocial support as needed. Methods: A cross-sectional analysis of distress and need of psychosocial care was done in 301 patients undergoing treatment for BC by 2 questionnaires (Distress Thermometer [DT] and Hornheider Screening Instrument). Results: Of the 301 patients, 230 patients underwent transurethral resection for a first ­diagnosis, 63 for recurrent disease, 37 had progressive disease, and 25 had advanced metastatic disease and eventually died of BC. The mean stress level in all patients was 4.6. Twenty-eight percent of the patients expressed a need for psychosocial support. In patients with progressive disease, significantly higher stress scores were seen as well as a higher need of psychosocial care (5.4 and 41%). Conclusions: The median DT-level of 4.6 indicates moderate psychosocial stress in BC patients. From a stress level of 5, the recommendations of a psycho-oncological supervision are pronounced, so that our study showed that early systematic evaluation of psychosocial needs in BC patients is important.

Cancer patients\u2019 wish for psychological support during outpatient radiation therapy

BackgroundCancer patients frequently suffer from physical and psychosocial impairments due to their disease and its treatment. Psychooncology (PO) can help to cope with stress resulting from outpatient radiotherapy (RT) treatment. There are currently few data regarding patients’ wishes for PO support. The aim of this study was to investigate the number of patients with a wish for PO, treatment paths, and predictors of the wish for PO among cancer patients at the beginning of RT.MethodsThe results of routine psychological stress screening (Hornheide screening instrument; cut-off ≥ 4) of 944 cancer patients between 2015 and 2017 were analyzed in a retrospective cross-sectional study. Predictors for a wish for PO support were identified by stepwise binary logistic regression, in which sociodemographic and treatment data were included in addition to the screening items.ResultsAround 20% of patients had above-average stress levels and 13% expressed a wish for PO support (participation rate was approximately 55%). Low emotional wellbeing (OR = 11.3) and lack of social support (OR = 9.4) were strong predictors for this treatment wish. Among patients with pancreatic cancer, head and neck tumors, and hematologic disease, there was a substantial difference between the degree of psychological stress and the wish for treatment. Patients with urological (23.5%) and lung tumors (20.9%) most frequently expressed a wish for PO support.ConclusionPatient-reported psychosocial problems were better predictors of a wish for PO support than sociodemographic or clinical data. Stress screening should thus be implemented in clinical routine.

Analysis of psychosocial stress factors in patients with renal cancer.

The experience of stress in patients with cancer through helplessness and the suppression of emotions correlates with unfavorable disease prognosis. Significant distress can reduce survival probability as well as subjectively perceived poor quality of life. Currently, there are few data on psychological stress in patients with renal cancer and most studies focus on survival time. The aim of the study was to evaluate the psychosocial stress of patients with renal cancer with screening questionnaires for an inpatient psychosocial treatment program. Patients undergoing inpatient surgical or medical treatment for renal cancer were prospectively assessed for psychosocial stress with two standardized stress screening questionnaires used for the identification of the need for psychosocial care [NCCN Distress Thermometer (NCCN-DT), Hornheider Screening Instrument (HSI)]. Seventy-four patients with a mean age of 65 years were assessed. The average NCCN-DT score was 4.8 (scale of 0-10) and did not correlate with tumor stage, sex or prognosis. According to the DT results, 27% of patients were in need of psychosocial care which was significantly higher than the self-reported need. The main stressors were anxiety (32%), pain (27%), nervousness (26%), sadness, worry and sleeping difficulties (20%). There is a significant number of patients with renal cancer with increased psychological distress and a consecutive need for psychosocial care. This is underreported and largely unrecognized by patients as well as physicians and nurses. Easy-to-use assessment tools can be very helpful in identifying patients in need and this information can be used to implement psychological support and thus improve patient care.

Identifying Psychosocial Distress and Stressors Using Distress-screening Instruments in Patients With Localized and Advanced Penile Cancer.

We examined the effects of treatment on the psychological well-being of patients with localized or advanced penile cancer using screening questionnaires to determine the consecutive need for psychosocial care. Penile cancer is a rare, but highly aggressive, malignancy. The psychological stress of patients with penile cancer arises from the cancer diagnosis per se and the corresponding consequences of treatment. In addition, cancer-specific distress results (eg, fear of metastasis, progression, relapse, death). Studies of the psychosocial stress of penile cancer patients are rare. We undertook a prospective analysis of the data from patients with penile cancer who had undergone surgery or chemotherapy from August 2014 to October 2016 at our department. Patients were evaluated using standardized questionnaires for stress screening and the identification for the need for psychosocial care (National Comprehensive Cancer Network Distress Thermometer and Hornheider screening instrument) and by assessing the actual use of psychosocial support. The average stress level was 4.5. Of all the patients, 42.5% showed increased care needs at the time of the survey. Younger patients, patients undergoing chemotherapy, and patients with recurrence were significantly more integrated with the psychosocial care systems. Finally, 67% of all patients received inpatient psychosocial care. Owing to the potentially mutilating surgery, patients with penile cancer experience increased psychological stress and, consequently, have an increased need for psychosocial care. Therefore, the emotional stress of these patients should be recognized and support based on interdisciplinary collaboration offered.

Psychological stress in geriatric patients with genito-urinary cancers.

Two-thirds of all cancer cases affect patients who are older than 65years, yet the specific conditions of the treatment and supportive care in this age group are poorly studied. There are limited data on the specific psycho-oncological problems in elderly patients with genito-urinary cancers. The aim of this study was to investigate the psychosocial needs of elderly patients with genito-urinary tumors using screening questionnaires and to use such screening questionnaires for an in-patient psychosocial treatment program. Patients (≥65years, n=319) who underwent surgical (n=295) or medical treatment (n=24) for genito-urinary malignancies between 06/2014 and 11/2015 in our institution were included for prospective stress assessment. This was done with standardized questionnaires for stress screening and for the identification of need for care (NCCN Distress Thermometer and Hornheider Screening Instrument, HSI). The patients scored an average of 4.4 on the Distress Thermometer. According to the survey evaluation, 28% of patients had need for psychosocial care. However, only a minority of patients (4%) did actually communicate any need for psychosocial care. We also assessed the actual utilization of inpatient psychosocial support which is offered to all patients. There is a significant number of elderly patients with genito-urinary cancer with increased psychological stress and a consecutive need of psychosocial care. This is underreported and underused by the patients. Therefore, an easy low-threshold access system with an interdisciplinary and inter-professional collaborative support system would be desirable. Measuring psychological distress systematically can be helpful in treating older patients with malignant diseases.

Psychosocial burden and desire for support in outpatients with skin cancer.

An important basis for adequate psycho-oncological and psychosocial care of cancer patients is the regular assessment of their psychosocial distress and thus their need for care. For this purpose, there are numerous questionnaires available. The objective of the present study was to assess whether distressed patients require professional support and which screening instrument outpatients with skin cancer prefer. In a cross-sectional survey, we asked outpatients with skin cancer to fill out three questionnaires assessing psychosocial stress, and to indicate which one they considered most adequate. Patients were offered the following three instruments: Hornheide Questionnaire (27 items), Hornheide Screening Instrument (7 items), and the Distress Thermometer. In addition, we inquired about the patients' desire for support. (1) Comparing subjective distress and patients' declared desire for support revealed a marked divergence. While one-third of the 137 patients were identified as being in need of care, only 11.5% of the sample requested such support. (2) 63.7% of patients chose the long version of the Hornheide Questionnaire. In addition to their psychosocial burden, patients' desire for support should be assessed. Moreover, apart from screening tools, other ways to provide access to psychosocial care should be considered.

Assessing the need for psychooncological support: screening instruments in combination with patients' subjective evaluation may define psychooncological pathways.

Cancer patients suffer from severe distress. About one third show mental comorbidities. Nevertheless, there is no common agreement on how to measure distress or identify patients in need for psychooncological services using screening questionnaires. A sample of N = 206 patients with confirmed breast cancer, being inpatient for surgical treatment, filled in distress assessment instruments: Distress Thermometer, Hospital Anxiety and Depression Scale, Patient Health Questionnaire 2, Hornheider Screening Instrument and parts of the EORTC-QLQ-C30. Additionally, they were asked for their subjective need for psychooncological counselling. The correlation between the assessment instruments is low to medium. The number of patients above the cut-off criteria varies quite a lot according to the instrument (10% to 66%). Therefore, the congruence between the instruments' indications is quite low. Patients with and without subjective need do not differ in personal data but in distress scores. Recommended instruments for distress assessment in psychooncology measure different areas of distress. They do not sufficiently agree in indicating a patient's need for psychooncological treatment. Hence, one should neither compare results of studies using different assessment instruments nor implement a screening without reflecting the used instrument's characteristics compared to the others. The subjective need seems to provide additional information to the assessment. At present, the combination of an assessment instrument and patients' subjective need is seen as a best practice for identifying patients in need of psychooncological treatment.

Need for psychosocial assistance in patients undergoing cardiothoracic surgery evaluated by a seven-item questionnaire.

Cardiothoracic surgery can have adverse effects on the patients' psychosocial well-being which may influence the overall prognosis. In this study, we tested the use of a seven-item screening instrument for the preoperative identification of need for psychosocial assistance in cardiothoracic patients. Methods and A total of 297 consecutive patients (69% male) with a median age of 70 years (59;75) completed the seven-item Hornheide Screening Instrument (HSI) on the day of admission. According to questionnaire scores predefined in the literature (cutoff ≥ 4), 130 patients (44%) exhibited a need for psychosocial support. We found female patients to have significantly higher need for psychosocial support than male patients, irrespective of their age, New York Heart Association classification or Canadian Cardiovascular Society classification, and the type of surgery they were undergoing (53 vs. 41%, p=0.034). In addition, we found that preoperative need for psychosocial support, using the predefined cutoff criterion as well as a higher absolute score, was associated with a prolonged length of hospitalization (p<0.05). We found the HSI to be a suitable tool to identify psychosocial need in cardiothoracic patients. The relatively high incidence of these patients in our study concurs with previous studies, which generally used more complex instruments. In addition, we found that preoperative scores were associated with prolonged length of stay. Therefore, the use of this questionnaire could represent an alternative, more rapid tool for the psychosocial assessment of cardiothoracic patients in daily routine.

Postsurgical screening for psychosocial disorders in neurooncological patients

The diagnosis of a brain tumor can cause severe psychosocial distress, which can have a variety of negative consequences on patients' physical and mental well-being. The detection of psychosocial distress in daily clinical routine is difficult and subsequent referral to mental health professionals is rare. The aim of this study was to determine the incidence of psychological disorders of patients early postoperatively and to investigate both the Hornheide Screening Instrument (HSI) and Distress Thermometer (DT) as screening tools in neurooncological practice. One hundred and thirty-four patients with brain tumors of different histology were postoperatively evaluated by the Distress Thermometer and Hornheide Screening Instrument. Additionally, correlation to gender, age, localization of the tumor, Karnofsky performance score and tumor entity were analyzed. After initial surgery 36 patients (26.9 %) showed pathologic results in the HSI and 50 patients (36.7 %) were severely distressed (DT Score≥6). Women had the highest rate of psychological disorders, followed by patients suffering from gliomas and meningiomas. Further highlighting the results of both tests, over 80 % of those patients who scored pathologically in both tests were in need of professional psychiatric help due to depression. Both the DT and HSI are suitable instruments for identifying patients in psychological distress after brain tumor surgery in neurooncological routine. Our results confirm that nearly one third of patients are unable to overcome the difficulties facing the diagnosis of a brain tumor in this early situation and should be supported by mental health professionals.

Der Zusammenhang zwischen psychoonkologischem Betreuungsbedarf, Wunsch nach Unterstützung und tatsächlicher Behandlung bei Krebspatientinnen und -patienten

The aim of the study was to examine the association between the need for psychosocial support, the patients' desire for support and the actually received psychosocial interventions in cancer patients. The need for psychosocial support was assessed with the Hornheider Screening Instrument (HSI ³ 4) in 455 cancer patients. The subjective desire for psychosocial support was assessed with a single question. In addition, the actually received psychosocial interventions were retrieved from the hospital documentation system of the psycho-oncology service. Overall, 41.8% of the participants received a positive screening result indicative for the need for psychosocial support, 19.8% reported a desire for support, and 41.5% actually received at least one psychosocial intervention. The agreement between objective need and subjective desire for psychosocial support was low (k = 0.352). Received psychosocial interventions were significantly associated with the subjective desire but not with the objective need for support as assessed with the HSI. The low associations between need and desire for psychosocial support as well as between need and actually received psychosocial interventions suggest that the decision for psychosocial support should be based on the objective as well as the self-reported need for help.

Development of a screening tool for the identification of psychooncological treatment need in breast cancer patients

In breast cancer patients the diagnosis, treatment and aftercare of the physical disease cause a large amount of psychosocial distress, which can have a variety of negative consequences on patients' physical and mental well-being. Although about one-third of the patients show heightened psychosocial distress that may require psychooncological interventions its detection in daily clinical routine is poor and referral to mental health professionals is insufficient. The aim of the study was to develop a short screening tool for the detection of need for psychooncological treatment (POT) in breast cancer patients. Over a period of six months, 115 breast cancer outpatients attending the Department of Gynaecology at Innsbruck Medical University were consecutively included in the study. Logistic regression analysis and ROC analyses were used to identify the most predictive item set from a set of questionnaires (EORTC-QLQ-C30, HADS and Hornheide Screening Instrument) and other additional questions. Data from 105 breast cancer patients (mean age 58.8, SD 12.3) were available for analysis. A logistic regression equation containing the EORTC-QLQ-C30 scales Emotional Functioning and Role Functioning as well as the yes-no question after psychiatric/psychological/psychotherapeutic treatment at any point in lifetime showed highest predictive power with regard to need of POT (AUC=0.88; CI 95% 0.82-0.95). A pilot study (n=20) investigating applicability of a computerized version of this screening tool in oncological routine showed high acceptance and feasibility. The developed PO-screening tool showed high diagnostic accuracy regarding POT needs. The short assessment time and good usability of its computerized version allowed easy implementation in daily oncological routine.