.. docs/source/tasks/fast.rst .. Copyright (C) 2012, University of Cambridge, Department of Psychiatry. Created by Rudolf Cardinal (rnc1001@cam.ac.uk). . This file is part of CamCOPS. . CamCOPS is free software: you can redistribute it and/or modify it under the terms of the GNU General Public License as published by the Free Software Foundation, either version 3 of the License, or (at your option) any later version. . CamCOPS is distributed in the hope that it will be useful, but WITHOUT ANY WARRANTY; without even the implied warranty of MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the GNU General Public License for more details. . You should have received a copy of the GNU General Public License along with CamCOPS. If not, see . .. _fast: Fast Alcohol Screening Test (FAST) ---------------------------------- History and guide ~~~~~~~~~~~~~~~~~ Original: Hodgson et al. (2002) [#hodgson2002]_. Sources ~~~~~~~ - Hodgson et al. (2002) [#hodgson2002]_. - NICE [#nicedefunct]_, Public Health England [#phegeneral]_ [#phefast]_. - The FAST manual [#fastmanual]_. Notes on the method of administration and scoring ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This is slightly trickier than it appears at first glance -- there are a couple of administration guidelines that differ very slightly, but the scoring method is consistent. **Development** Hodgson et al. [#hodgson2002]_ developed the FAST from the AUDIT, seeking a quick version. They had the aim that one question serves as a first filter. AUDIT Q3 was found to be good for that. They modified it to use a threshold of ≥8 units for men. They found that AUDIT Q5, Q8, and Q10 were collectively the best for a second-stage filter, with minor modifications. The four FAST questions are therefore approximately as follows: - FAST Q1: How often ≥6 units (female) or ≥8 units (male) on a single occasion in the last year? = AUDIT Q3, approximately, but not quite. - FAST Q2: ... failed to do what was normally expected... = AUDIT Q5. - FAST Q3: ... unable to remember... the night before... = AUDIT Q8. - FAST Q4: ... relative/friend/doctor/health professional... concerned = AUDIT Q10. The test is referred to as a two-stage screening test (e.g. Abstract). **Administration** There seems to be a slight difference in administration instructions between different sources of the test. The original paper [#hodgson2002]_ says (p62): *"AUDIT Question 3 [= FAST Q1]... served as the best first filter... If the response is 'never'... then there is no hazardous use. If the response is 'weekly'/'daily or almost daily'... then there is probably hazardous use... this one questions classifies... 66%... with an accuracy of 97%. Only the 34% of patients who responded 'less than monthly' or 'monthly' to [AUDIT] Question 3 [FAST Q1] need to be asked further questions"*. The FAST manual says that *"a response must be obtained for each question... In the case of self-completion, a staff member... should check that all questions have been answered"* ([#fastmanual]_, page 6), although it is not necessary to score all (depending on Q1). There is no suggestion that one should not *answer* Q2-Q4 if certain answers are given to Q1. The paper version of the test simply says *"For the following questions, please circle the answer..."* Public Health England says that *"the test consists of only 4 questions... which are asked in 2 stages"* [#phegeneral]_. It clarifies that one should *"only answer the following questions [Q2-Q4] if the answer above [to Q1] is Never (0), Less than monthly (1) or Monthly (2). Stop here if the answer is Weekly (3) or Daily (4)"* ([#phefast]_, page 1). I presume that PHE trimmed the administration procedure a little for speed, without any change to the scoring methodology (see below). **Scoring** Hodgson et al. [#hodgson2002]_ considered two scoring methods (p64): - Both methods decide "FAST negative" if the response to Q1 is "Never". - Both methods decide "FAST positive" if the response to Q1 is "weekly" or "daily or almost daily". Then: - Method 1 (not preferred): FAST negative if (FAST) Q2 and Q3 are "Never" and Q4 is "No"; FAST positive for all others (i.e. positive for any hint of a problem). - Method 2 (preferred): all questions are scored 0-4 and the result is FAST positive if the total score for all four questions is ≥3. - In more detail: questions Q1-Q3 have five options and are scored 0-4; question Q4 has three options, scored 0, 2, and 4. The original paper prefers Method 2 [#hodgson2002]_. The FAST manual uses Method 2 [#fastmanual]_. The PHE scoring method is Method 2 [#phefast]_. So that's clear. *CamCOPS* CamCOPS marks all four questions as mandatory, following the FAST manual, and following the principle of collecting more data (given also some ambiguity) in a patient-completed questionnaire. Note also that the original validation involved a questionnaire in which participants saw and answered all four questions. Reviewed 2019-11-01. The scoring method was correct; see ``fast.cpp`` in the :ref:`source code ` and :func:`camcops_server.tasks.fast.Fast.is_positive`. Explanatory text added here. Intellectual property rights ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Believed to be in the public domain. - Made freely available with encouragement to copy by the UK NHS Health Development Agency and the UK National Institute for Clinical Excellence [#nicedefunct]_ and subsequently by Public Health England [#phegeneral]_ [#phefast]_ along with the AUDIT. - Developed from the :ref:`AUDIT ` (q.v.) =============================================================================== .. rubric:: Footnotes .. [#hodgson2002] Hodgson R, Alwyn T, John B, Thom B, Smith A (2002). The FAST Alcohol Screening Test. *Alcohol and Alcoholism* 37: 61-66. http://www.ncbi.nlm.nih.gov/pubmed/11825859 .. [#fastmanual] Hodgson R, Alwyn T, John B, Smith A, Newcombe R, Morgan C, Thom B, Hodgson R, Waller S [2006, by PDF date]. Fast screening for alcohol problems: manual for the FAST Alcohol Screening Test [v3, by PDF document title]. http://www.dldocs.stir.ac.uk/documents/fastmanual.pdf .. [#nicedefunct] UK National Institute for Health and Care Excellence. Document previously at http://www.nice.org.uk/niceMedia/documents/manual_fastalcohol.pdf (e.g. 2013), now gone (2019-11-01). See https://web.archive.org/web/2013*/http://www.nice.org.uk/niceMedia/documents/manual_fastalcohol.pdf. .. [#phegeneral] Public Health England (2017). Alcohol use screening tests. https://www.gov.uk/government/publications/alcohol-use-screening-tests; https://www.gov.uk/government/publications/alcohol-use-screening-tests/guidance-on-the-5-alcohol-use-screening-tests; https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684828/Fast_alcohol_use_screening_test__FAST__.pdf. .. [#phefast] Public Health England (2017). Fast alcohol screening test (FAST). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/684828/Fast_alcohol_use_screening_test__FAST__.pdf