Diagnosing adjustment disorder in patients with cancer: evaluation of the adherence, interrater agreement, and content of a guideline-based interview

Abstract

The aim of this study was to evaluate the adherence, interrater agreement, and content of a guideline-based semistructured interview for adjustment disorder (AD) in patients with cancer. In total, 120 AD interviews with patients with cancer were performed by 9 trained psychologists. The interview contained topics related to stressors, resilience, and symptoms and complaints. Audiotaped interviews of 72 patients were available. Adherence to the interview manual was scored by two researchers independently, and the average adherence was calculated per topic. Interrater agreement was calculated using Cohen's Kappa. The content of the interviews was evaluated using thematic analysis of the transcribed interviews of patients with an AD diagnosis. In the interviews, 97% of the topics were covered at least briefly and 78% of all topics were addressed at least adequately. Interviewers asked questions regarding stressors and symptoms and complaints more thoroughly compared with resilience. The interrater agreement regarding the AD diagnosis was moderate (Kappa 0.55). The content analysis showed that stressors and resilience can be additionally specified into physical, psychological, spiritual, and social themes, which are relevant to explore in the context of an AD diagnosis after cancer. The guideline-based interview for AD identifies problems and protective factors with adequate adherence and moderate agreement. A balanced investigation of stressors, resilience, and symptoms is important for optimal clinical decision-making regarding AD in the context of cancer.