Research Article| Volume 63, 102240, April 2023

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Screening and assessment for cancer patients' psychosocial support needs: Development and validation of the psychosocial risk questionnaire

Published:November 17, 2022DOI:


      • The PSR is a suitable instrument for assessing the support needs of cancer patients with regard to psychosocial problems.
      • Cut-off values of support needs items allow its use as a screening instrument in everyday clinical practice.
      • The PSR can provide information regarding further treatment options and thus support the implementation of personalized, needs-based care.



      Psychosocial factors can negatively influence the ability to cope with cancer-specific therapy. To identify high-risk patients and to offer need-based care concerning social issues, valid, reliable, and economic instruments are needed. This study aims to develop a tool assessing psychosocial support needs and analyze its psychometric properties.


      Based on an extensive literature search, items for the scale of psychosocial risks (PSR) were developed to assess the need for psychosocial support. Overall, N = 343 participants with cancer took part in the study to investigate the psychometric properties of the PSR. The factor structure was examined by using a principal component analysis. Correlations with criteria-related constructs determined the convergent validity. Cut-off scores for the PSR were selected based on receiver-operating characteristics and the calculation of Youden indices.


      The principal component analysis suggests a two-factor structure: (1) Psychosocial support need to ensure medical and social care services, and (2) Support need for coping with problems. The predicted correlations confirm the convergent validity. Both scales showed excellent internal consistency (Ensure medical and social care services: Omega = 0.94) and (Coping with problems: Omega = 0.90).


      The newly developed scale can provide helpful information regarding psychosocial support needs to professionals (psychotherapists, psychologists, physicians, and social workers) in the psycho-oncological field. Based on this information, specific and personalized interventions for cancer patients can be offered. The PSR is appropriate for assessing specific psychosocial needs to support cancer patients.


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        • Andrews G.
        • Kemp A.
        • Sunderland M.
        • Von Korff M.
        • Ustun T.B.
        Normative data for the 12 item WHO disability assessment Schedule 2.0.
        PLoS One. 2009; 4e8343
        • Bjelland I.
        • Dahl A.A.
        • Haug T.T.
        • Neckelmann D.
        The validity of the Hospital Anxiety and Depression Scale: an updated literature review.
        J. Psychosom. Res. 2002; 52: 69-77
        • Book K.
        • Marten‐Mittag B.
        • Henrich G.
        • Dinkel A.
        • Scheddel P.
        • Sehlen S.
        • Haimerl W.
        • Schulte T.
        • Britzelmeir I.
        • Herschbach P.
        Distress screening in oncology—evaluation of the Questionnaire on Distress in Cancer Patients—short form (QSC‐R10) in a German sample.
        Psycho Oncol. 2011; 20: 287-293
        • Butow P.
        • Palmer S.
        • Pai A.
        • Goodenough B.
        • Luckett T.
        • King M.
        Review of adherence-related issues in adolescents and young adults with cancer.
        J. Clin. Oncol. 2010; 28: 4800-4809
        • Carlson L.E.
        Screening alone is not enough: the importance of appropriate triage, referral, and evidence-based treatment of distress and common problems.
        J. Clin. Oncol. 2013; 31: 3616
        • Cwik J.C.
        • Vaganian L.
        • Bussmann S.
        • Gerlach A.L.
        • Labouvie H.
        • Houwaart S.
        • Kusch M.
        Assessment of coping with cancer-related burdens: psychometric properties of the cognitive-emotional coping with cancer (CECC) scale and the German mini-mental adjustment to cancer (Mini-MAC) scale.
        J. Psychosoc. Oncol. Res. Pract. 2021; 3: p e046
        • Faller H.
        • Weis J.
        • Koch U.
        • Brähler E.
        • Härter M.
        • Keller M.
        • Schulz H.
        • Wegscheider K.
        • Boehncke A.
        • Hund B.
        • Reuter K.
        • Richard M.
        • Sehner S.
        • Szalai C.
        • Wittchen H.U.
        • Mehnert A.
        Perceived need fo psychosocial support depending on emotional distress and mental comorbidtiy in men and women with cancer.
        J. Psychosom. Res. 2016; 81: 24-30
        • Finitsis D.J.
        • Vose B.A.
        • Mahalak J.G.
        • Salner A.L.
        Interventions to promote adherence to endocrine therapy among breast cancer suvivors: a meta-analysis.
        Psycho Oncol. 2019; 28: 255-263
        • Halbach S.M.
        • Ernstmann N.
        • Kowalski C.
        • Pfaff H.
        • Pförtner T.-K.
        • Wesselmann S.
        • Enders A.
        Unmet information needs and limited health literacy in newly diagnosed breast cancer patients over the course of cancer treatment.
        Patient Educ. Counsel. 2016; 99: 1511-1518
        • Hermann-Lingen C.
        • Buss U.
        • Snaith R.
        Hospital Anxiety and Depression Scale-Deutsche Version (HADS-D). Bern.
        Verlag Hans Huber, 2011
        • Herschbach P.
        Behandlungsbedarf in der Psychoonkologie.
        Onkologe. 2006; 12: 41-47
        • Herschbach P.
        • Marten-Mittag B.
        • Henrich G.
        Revision und psychometrische Prüfung des Fragebogens zur Belastung von Krebskranken (FBK-R23).
        Z. Med. Psychol. 2003; 12: 69-76
        • Hes V.
        • Meng K.
        • Schulte T.
        • Neuderth S.
        • Bengel J.
        • Faller H.
        • Schuler M.
        Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation.
        Psycho Oncol. 2020; 29: 1549-1556
        • Hinz A.
        • Schumacher J.
        • Albani C.
        • Schmid G.
        • Brähler E.
        Bevölkerungsrepräsentative Normierung der Skala zur Allgemeinen Selbstwirksamkeitserwartung.
        Diagnostica. 2006; 52: 26-32
        • Jenniches I.
        • Lemmen C.
        • Cwik J.C.
        • Kusch M.
        • Labouvie H.
        • Scholten N.
        • Gerlach A.
        • Stock S.
        • Samel C.
        • Hagemeier A.
        Evaluation of a complex integrated, cross-sectoral psycho-oncological care program (isPO): a mixed-methods study protocol.
        BMJ Open. 2020; 10e034141
        • Krebber A.
        • Jansen F.
        • Witte B.
        • Cuijpers P.
        • De Bree R.
        • Becker-Commissaris A.
        • Smit E.
        • Van Straten A.
        • Eeckhout A.
        • Beekman A.
        • Leeans C.
        • Verdonck-De Leeuw I.
        Stepped care targeting psychological distress in head and neck cancer and lung cancer patients: a randomized, controlled trial.
        Ann. Oncol. 2016; 27: 1754-1760
        • Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe & Awmf)
        S3-Leitlinie Psychoonkologische Diagnostik, Beratung und Behandlung von erwachsenen Krebspatienten. Langversion 1.1.
        (AWMF-Registernummer: 032/051OL [Online])2014 (Stand: 07.12.2020. [Accessed])
        • Macleod M.A.
        • Tremblay P.F.
        • Graham K.
        • Bernards S.
        • Rehm J.
        • Wells S.
        Psychometric properties and a latent class analysis of the 12‐item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a pooled dataset of community samples.
        Int. J. Methods Psychiatr. Res. 2016; 25: 243-254
        • Mehnert A.
        Psychosoziale Probleme von Langzeitüberlebenden einer Krebserkrankung.
        Onkologe. 2011; 17: 1143-1148
        • Mehnert A.
        • Müller D.
        • Lehmann C.
        • Koch U.
        Die deutsche Version des NCCN Distress-Thermometers: empirische Prüfung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten.
        Z. Psychiatr. Psychol. Psychother. 2006; 54: 213-223
        • Mehnert-Theuerkauf A.
        • Faller H.
        • Herschbach P.
        • Hönig K.
        • Hornemann B.
        • Petermann-Meyer A.
        • Zimmermann T.
        Psychoonkologischer versorgungsbedarf in krebszentren.
        Onkologe. 2020; 26: 178-184
        • Mehnert-Theuerkauf A.
        • Lehmann-Laue A.
        Psychother. Psychosom. Med. Psychol. 2019; 69: 141-156
        • Riba M.B.
        • Donovan K.A.
        • Andersen B.
        • Braun I.
        • Breitbart W.S.
        • Brewer B.W.
        • Buchmann L.O.
        • Clark M.M.
        • Collins M.
        • Corbett C.
        Distress management, version 3.2019, NCCN clinical practice guidelines in oncology.
        J. Natl. Compr. Cancer Netw. 2019; 17: 1229-1249
        • Sanson‐Fisher R.
        • Girgis A.
        • Boyes A.
        • Bonevski B.
        • Burton L.
        • Cook P.
        • Group S.C.R.
        The unmet supportive care needs of patients with cancer.
        Cancer. 2000; 88: 226-237
        • Singer S.
        • Danker H.
        • Roick J.
        • Einenkel J.
        • Briest S.
        • Spieker H.
        • Dietz A.
        • Hoffmann I.
        • Papsdorf K.
        • Meixensberger J.
        Effects of stepped psychooncological care on referral to psychosocial services and emotional well‐being in cancer patients: a cluster‐randomized phase III trial.
        Psycho Oncol. 2017; 26: 1675-1683
        • Singer S.
        • Das-Munshi J.
        • Brähler E.
        Prevalence of mental health conditions in cancer patients in acute care—a meta-analysis.
        Ann. Oncol. 2010; 21: 925-930
        • Singer S.
        • Hohlfeld S.
        • Müller-Briel D.
        • Dietz A.
        • Brähler E.
        • Schröter K.
        • Lehmann-Laue A.
        Psychosoziale versorgung von Krebspatienten.
        Psychotherapeut. 2011; 56: 386-393
        • Strittmatter G.
        • Mawick R.
        • Tilkorn M.
        Development of the Hornheide Screening Instrument (HSI) for the identification of cancer patients in need of support.
        J. Cancer Res. Clin. Oncol. 2000; 126: 36
        • Vaganian L.
        • Bussmann S.
        • Boecker M.
        • Kusch M.
        • Labouvie H.
        • Gerlach A.L.
        • Cwik J.C.
        An Item Analysis According to the Rasch Model of the German 12-item WHO Disability Assessment Schedule (WHODAS 2.0).
        Quality of Life Research, 2021: 1-10
        • Weis J.
        • Giesler J.M.
        • Bergelt C.
        Psychoonkologie in der Rehabilitation. Psychologie in der medizinischen Rehabilitation.
        Springer, 2020