New 18-Item Instrument Speeds Psychosocial Screening

NEW YORK—A simplified version of the Brief Symptom Inventory (BSI) that can be completed by patients in less than 2 minutes is speeding screening and referral for psychosocial problems at Johns Hopkins University cancer clinics.

Derived from the original 53-item Likert scale, the new BSI-18 is designed specifically for cancer patients, James R. Zabora, ScD, associate director of community research, Johns Hopkins Oncology Center, reported at the Pan American Congress of Psychosocial & Behavioral Oncology.

“We’ve reduced it to 18 essential items and an additive scoring process so that we can complete the screening in about a minute or a min-ute and a half of patient time,” he said. The additive scoring of the instrument also takes about a minute. (The scoring method was developed by Leonard Derogatis, PhD, director of the Office of Research, School of Nursing, University of Maryland, Baltimore.)

In contrast to the BSI-18, the 53-item scale requires 5 to 7 minutes for most patients to complete, and some may take as long as 20 minutes, Dr. Zabora noted. Scoring of the longer scale is also more cumbersome, a major consideration in dealing with more than 4,000 new patients per year, he said.

More Than 1,500 Cases Screened

Dr. Zabora and his colleagues extracted 1,543 cases from the Johns Hopkins database of patients screened with the original instrument, and used this information to establish the reliability and validity of the BSI-18, and focus it on items of particular relevance to cancer patients. The patients, Dr. Zabora noted, had 16 different cancer diagnoses.

“We got an alpha of .89 on the BSI-18,” he said. “The correlation between the BSI-18 and the full BSI was also very high, at .84.”

NCS Assessments holds the copyright on BSI-18 and plans to market it. “I will not derive any income from it,” he said, “so there’s no conflict of interest.”

The BSI-18 provides an overall distress assessment and also scores for anxiety, depression, and somatization. “Scoring is done by trained volunteers, graduate students, or support staff,” Dr. Zabora said.

Patients also get a problem checklist that takes about 4 minutes to complete and a genetic risk screen. “They also receive a resource service list and list of home care agencies,” Dr. Zabora said. “The total time is about 15 minutes, and we can deliver a great deal of information and get back some very valuable data.”

The BSI-18 is part of a structured pathway from screening to intervention that takes place within the first week of care, Dr. Zabora said. Any patient who reveals suicidal ideation on the screening is referred immediately, he noted, but all referrals for psychosocial services are completed within 24 hours.

Continuity for the Patient

The same social worker sees the patient throughout his or her illness, providing continuity. The social worker makes an initial phone call and follows up again within 5 working days, and also develops a plan of care that is entered into the patient’s chart and communicated to the attending physician. If phone contact is not made, a letter signed by the oncology social worker is sent to any patient with high distress levels, to explain the services available.

“Our goal is that all patients coming through our cancer center receive the BSI-18 and the problem checklist, and that we move them appropriately toward the care they need,” Dr. Zabora commented.

The ultimate goal is to re-screen patients with the instrument every 6 months. “But I’m not adding any additional steps to the pathway,” he said, “until I know we’re reaching patients, identifying them, and linking them to the services appropriately.”