Psycho-Oncology Psycho-Oncology 20: 1324–1333 (2011) Published online 5 October 2010 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.1859 Distress screening, rater agreement, and services in pediatric oncology Sunita K. Patel à , Wendy Mullins, Anne Turk, Noya Dekel, Christine Kinjo and Judith K. Sato Departments of Population Sciences, Pediatrics, and Support Care, City of Hope Medical Center, Duarte, California, USA Abstract Objective: Empirically based data support the validity of the distress thermometer recommended by the National Comprehensive Cancer Network as a standard screen for patient distress. However, the feasibility and utility of the distress thermometer has not been studied in the pediatric oncology setting. We conducted a study to: (1) investigate the validity of an adapted distress thermometer with pediatric oncology patients, (2) assess the degree of agreement among different respondents, including physician and psychosocial staff, with respect to (a) the pediatric cancer patient’s distress and (b) the caregiver/parent’s distress, and (3) to evaluate the relationship between distress levels and the psychosocial services provided to patients and families. Methods: Ninety-one patients and their English and Spanish-speaking caregivers were prospectively assessed at 3-month intervals for 1 year. The quantity of psychosocial services provided to each family was logged for a 12-month period. Results: Convergent validity was demonstrated by reasonable agreement between the pediatric distress rating tool and standardized measures. Additionally, the demographic and medical predictors of distress were consistent with previously reported findings using more extensive assessment. There was reasonable agreement among multiple raters of the child’s distress; however, there was discrepancy between self-ratings of caregiver distress and psychosocial staff ratings of caregiver distress. This difference in perception impacted the quantity of psychosocial services provided following the baseline assessment. Conclusion: The single-item distress thermometer is a viable option as a rapid screening tool of patient and caregiver distress to help efficiently identify those who should be evaluated further. Copyright r 2010 John Wiley & Sons, Ltd. Keywords: childhood cancer; psychosocial services; distress screening; caregiver distress; quality of care; psychological Introduction Given the understanding that cancer and its treatment can result in a range of persisting physical and psychological problems, a number of guidelines, typically based on consensus, exist to aide in timely assessment and clinical care [1]. With adult patients, empirically based data have emerged to support the validity of the distress thermometer recommended by the National Com- prehensive Cancer Network (NCCN) as a standard screen for patient distress [2–10]. However, the feasibility and utility of the distress thermometer has not been studied in the pediatric oncology setting. Furthermore, little is known about the relation- ships between distress screening and the delivery of psychosocial services in oncology clinics, even for adults. There is only one study to our knowledge with a systematic designation of psychosocial interventions. The approach, pioneered by Kazak et al. [11], uses a two-page family questionnaire to tailor an optimal fit between patient/family need and psychosocial care. The public health concep- tual framework of ‘universal’, ‘selective’, and ‘indicated’ levels of need or risk direct the provision of both broad and targeted interventions, differen- tially based on patient risk [12]. Although this strategy appears well integrated into the routine care provided at their particular site, it remains important to investigate other approaches that may be as feasible for other pediatric cancer centers. We conducted a study to assess the validity and utility of an adapted distress thermometer as a rapid screening tool in the pediatric oncology setting. The adapted tool retained the approach utilized by the NCCN for the adult distress thermometer, where distress is viewed as a general emotional concept and represents a range of emotional concerns, including sadness, worry, and fear [1]. We intended the pediatric tool as a rapid screening measure that potentially can be * Correspondence to: Room 105, Building 173, City of Hope Medical Center, 1500 E. Duarte Road, Duarte, CA 91010, USA. E-mail: spatel@coh.org Received: 12 January 2010 Revised: 13 August 2010 Accepted: 24 August 2010 Copyright r 2010 John Wiley & Sons, Ltd.