Lastmeter / Distress Thermometer and Problem List

Abstract

The Distress Thermometer (DT), often paired with the Problem List (PL), is a widely used screening tool primarily developed for cancer patients to assess the psychological and emotional burden they experience. Distress is broadly defined as any negative influence on a patient’s life that prevents them from engaging in activities enjoyed prior to diagnosis. The DT measures the intensity of distress felt over the past week using a simple 0-10 analog scale, reflecting the patient’s emotional load (Lastmeter), including stress, tension, anxiety, depression, and anger.

The companion Problem List (PL) serves as a rapid inventory, allowing patients to identify specific areas contributing to their distress. This self-administered questionnaire requires only yes/no responses and covers five critical domains: practical, family/social, emotional, religious/spiritual, and physical problems. Together, the DT and PL provide the medical team with comprehensive insight into the patient’s immediate concerns, facilitating targeted psychological intervention and support.

Keywords

Distress Thermometer, Problem List, Lastmeter, psychological screening, cancer patients, emotional burden, psychological assessment, health psychology, psychological disorders, psychosocial support.

Authors

Roth AJ, et al (1998), Bannink M (2004), Tuinman M, et al (2008).

Purpose

The primary purpose of the Distress Thermometer and Problem List is to provide rapid and effective screening for significant distress among medical patients, particularly those diagnosed with chronic or severe illness. It functions as a quick triage tool, identifying patients who require further psychological evaluation or immediate psychosocial intervention. By quantifying distress (DT score) and identifying its sources (PL domains), the instrument helps bridge communication gaps between patients and their healthcare providers.

Furthermore, the scale aims to normalize the experience of emotional burden in the context of severe illness. It ensures that the medical team gains crucial insight into the patient’s holistic state, addressing issues that extend beyond physical symptoms, such as practical concerns or spiritual needs, thereby promoting integrated care models for adults and the elderly.

Construct

The central construct measured by the DT is global psychological distress. This construct encompasses a range of negative affective states, including generalized stress, tension, anxiety, depression, and anger, often referred to collectively as emotional burden. The scale operationalizes this construct unidimensionally using a numerical rating scale, assuming that higher scores reflect a greater need for psychological support.

The Problem List, used in conjunction with the DT, measures the construct of psychosocial problem inventory. It maps specific stressors across multiple life domains (practical, social, emotional, spiritual, physical). This multi-domain assessment ensures that the complex nature of distress, often rooted in specific life challenges resulting from illness, is systematically cataloged for clinical action.

Validity

The original source confirms a Dutch validated version (Tuinman M, et al, 2008), indicating established psychometric soundness. The instrument generally demonstrates strong face and content validity due to its direct measurement of patient-reported distress and problems relevant to chronic illness. Studies often focus on establishing criterion validity, comparing DT scores against established measures of anxiety and depression, such as the Hospital Anxiety and Depression Scale (HADS).

The clinical utility of the DT/PL pairing provides evidence of ecological validity, as its simplicity and speed make it highly effective for routine clinical screening. Successful validation studies confirm that scores above a specific cutoff reliably predict the presence of clinically significant distress requiring follow-up assessment for psychological disorders.

Reliability

As a single-item measure, the Distress Thermometer’s reliability is typically assessed through test-retest reliability, demonstrating consistency in scores over short periods when the patient’s clinical status is stable. The Problem List, functioning as a checklist, exhibits high inter-rater reliability since it relies on objective yes/no responses to concrete problem domains.

The Dutch validated version (Tuinman M, et al, 2008) examined the overall stability and consistency of the instrument, confirming that the tool maintains the necessary reliability for application in clinical settings involving adult and elderly populations facing conditions like cancer or other serious physical ailments.

Factor Analysis

The Distress Thermometer is a single-item measure and is not subjected to traditional factor analysis. However, the accompanying Problem List, which comprises multiple items grouped into five defined domains (practical, family/social, emotional, religious/spiritual, physical), has been analyzed structurally in various research contexts. These analyses typically confirm the intended multi-domain structure, supporting the grouping of specific problems into distinct factors related to the patient’s overall psychosocial burden.

The confirmed factor structure of the PL ensures that interventions can be tailored to address specific clusters of problems (e.g., practical difficulties versus emotional distress), providing a nuanced understanding of the patient’s experience beyond the global score provided by the DT.

Instrument

Test Type: Screening Questionnaire / Visual Analog Scale

Format: The Distress Thermometer uses a visual analog scale ranging from 0 to 10. The Problem List is a brief, self-report checklist utilizing dichotomous (Yes/No) response options.

Language Available: Original (English/US); Dutch validated version (Nederlandse gevalideerde versie).

Population Group: Clinical populations, primarily oncology patients. Applicable to patients dealing with severe or chronic illness, focusing on mental functions and psychological disorders.

Age Group: Adults, Elderly

Population Details: Originally developed for cancer patients, its utility has been recognized across various patient groups experiencing significant health-related distress, requiring self-assessment of emotional and practical burdens.

Test Methodology: Self-administered, rapid assessment tool designed for use in clinical settings to facilitate quick identification of psychological needs and inform supportive care decisions.

Keywords

Oncology screening, psychosocial distress, emotional burden, pain scale, patient-reported outcomes, mental functions, supportive care, clinical assessment.

Authors

Author ORCID Identifier: N/A

Affiliation Email addresses: N/A

Correspondence Address: N/A

Permissions & Fee and Test Year

The original Distress Thermometer was published by Roth AJ, et al in 1998. The Dutch adapted version was introduced by Bannink M in 2004, and the Dutch validated version was established in 2008 by Tuinman M, et al. The scale is widely considered a public domain tool for clinical use, reflecting its intended purpose as a widespread screening instrument.

The scale is generally used clinically without an associated fee for administration. Permissions for specific adaptations or translations should be sought from the corresponding research teams.

Reference’s

• Roth AJ, Kornblith AB, Batel-Anson C, et al. (1998). Rapid screening for psychosocial distress in cancer patients: a new measure. Cancer Practice, 6(3), 165-170.
• Bannink M. (2004). Adaptation of the Distress Thermometer and Problem List for the Dutch population. (Dutch adapted version).
• Tuinman M, Hagedoorn M, Hoekstra-Weebers JEH, et al. (2008). The Distress Thermometer and Problem List: a valid and reliable screening instrument for psychosocial distress in Dutch cancer patients. Supportive Care in Cancer, 16(11), 1251-1258.
• The original PDF explanation form (‘Toelichtingsformulier’) can be downloaded here: https://scales.arabpsychology.com/wp-content/uploads/instrumenten/Lastmeter-en-Probleemlijst-form-1.pdf
• The original PDF measurement instrument (‘Meetinstrument’) can be downloaded here: https://scales.arabpsychology.com/wp-content/uploads/instrumenten/Lastmeter-en-Probleemlijst-meetinstr-1.pdf

Items of the Lastmeter / Distress Thermometer en Probleemlijst / Problem List

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source content did not provide the full list of specific items, but described the components and domains utilized by the instrument pairing:

• The Lastmeter / Distress Thermometer (DT): A visual analog scale requiring the patient to score the level of distress experienced over the past week on a range from 0 (geen last / No distress) to 10 (extreme last / Extreme distress).
• The Probleemlijst / Problem List (PL) is a dichotomous checklist (Ja/Nee) covering five domains of potential problems:
• Praktisch (Practical)
• Gezin/Sociaal (Family/Social)
• Emotioneel (Emotional)
• Religieus/Spiritueel (Religious/Spiritual)
• Lichamelijk (Physical)