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Comment on ‘Psychological distress in patients with cancer: is screening the effective solution?'

Screening for psychological distress in patients with cancer is currently being debated in the British Journal of Cancer. Screening has been recommended, as elevated levels of distress have been consistently observed and clinicians tend to overlook the need of psychological support (Carlson et al, 2012; Carlson et al, 2013; National Comprehensive Cancer Network, 2013). On the other hand, it has been argued that screening should not be implemented, as the true benefit of screening and subsequent treatment of psychological distress is far from being definitively proven (Coyne, 2013). Recent findings on human resilience in the face of potentially traumatic events (PTEs) provide a new perspective on detecting and treating psychological distress in patients with cancer. Humans show strong resilience in the face of potentially traumatic events, such as cancer diagnosis and treatment (Bonanno et al, 2011). This observation leads us to propose two alternative approaches towards detecting and treating psychological distress in patients with cancer: ‘screening for psychological distress’ and ‘supporting resilience and case finding’.

The ability of four frailty screening instruments to predict mortality, hospitalization and dependency in (instrumental) activities of daily living

The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3±6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specifcity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62–0.65, 0.59–0.63 and 0.60–0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specifcity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specifcity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specifcity, whereas sensitivity was higher for the GFI and TFI.

The Delirium Observation Screening Scale: A Screening Instrument for Delirium

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Validity and compatibility of the SAM and KLD screening instruments

In this paper validity and compatibility of the SAM and KLD screening instruments are the central themes. A screening instrument can be called valid if it identifies performance that is important to society. A screening instrument is called compatible if these instruments can be used interchangeably. Validity The outcome of the content-analysis approach suggest that there is clearly not a perfect match between the SAM and KLD instruments and the CSAF, indicating that the SAM and KLD screening instruments taken the CSAF as the standard, cannot be called valid measures of corporate sustainability performance. However, as discussed earlier, assessing validity is not a binary phenomenon. A simple ‘yes’ or ‘no’ will not do. To make things more complicated, the validity of a measure also depends on the aggregation level under observation. It makes a big difference if validity is assessed at a high (i.e. Dimension) or low aggregation (i.e. Sustainability Item) level . At the highest level there is a perfect match with the CSAF, indicating that both screening instruments are valid measures of corporate sustainability performance. At the lowest level the situation is quite different. Here we see that overlap is relatively poor. Besides, the weight distributions of the SAM and KLD instruments and the CSAF are also largely dissimilar. When we break the validity discussion down to the Dimension level, we can see that overlap between the SAM and KLD instruments is also relatively poor, although the SAM instrument is slightly more attuned to the CSAF than the KLD instrument. This most notably applies to the Governance Dimension. The SAM instrument scores relatively poor on environmental issues. This is due to the fact that we analyzed the generic (i.e. non-industry specific) screening instrument. SAM typically addresses environmental issues in industry specific supplements. CompatibilityThe second question in this study concerns the compatibility of the SAM and KLD screening instruments. Or more accurately phrased: the extent to which these rating schemes are compatible. If we would consider compatibility assessment of screening instruments as a binary phenomenon, then we should conclude that the SAM and KLD instruments are not compatible.However, just like validity, assessing the compatibility of screening instruments is not a binary phenomenon. The extent to which the rating schemes of the two SRAs are compatible relates to the aggregation level. At the highest aggregation ( or Dimension) level the screening instruments are perfectly compatible. Both instruments cover governance, social, environmental and economic issues. At the lowest (or Sustainability Item) level the situation is quite different. At this level compatibility of both instruments is poor. Overlap is poor and the weight distributions are hardly correlated. Obviously both instruments are reflect different interpretations of corporate sustainability performance. Compatibility is highest for the Social Dimension. For the Governance, Environment and Economic Dimension compatibility is very poor. The overall conclusion should therefore be that that compatibility of the SAM and KLD screening instruments is (very) poor and that for this reason these instruments cannot

Can the combined use of two screening instruments improve the predictive power of dependency in (instrumental) activities of daily living, mortality and hospitalization in old age?

Background: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. Objective: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. Design, setting and participants: A prospective cohort study with two-year followup was conducted among pre-frail and frail community-dwelling older people in the Netherlands. Measurements: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. Results: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. Conclusions: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.

The language-screening instrument SNEL