NEW YORKA 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 &
Weve 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
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,
NCS Assessments holds the copyright on BSI-18 and plans to market it.
I will not derive any income from it, he said, so
theres 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.
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 patients 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 Im not adding any additional steps to the
pathway, he said, until I know were reaching
patients, identifying them, and linking them to the services