Accuracy of oncologist assessments of psychiatric problems in cancer inpatients

Yasugi, Daisuke; Tamune, Hidetaka; Sawamura, Jitsuki; Nishimura, Kazuhiko

doi:10.1017/s147895151700027x

Cited by 7 publications

(10 citation statements)

References 41 publications

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“…The accurate assessment of delirium in HF by cardiologists occurred in approximately half of all cases. It has been reported that the correct assessment rate of delirium by non-psychiatrists is 87% in patients with cancer [18] and 69% in elderly patients [17]. In the current study, we only considered cases in which cardiologists explicitly stated "delirium" as the correct detection of delirium, which is a more precise definition of delirium than that used by previous studies [17,18].…”

Section: Discussionmentioning

confidence: 99%

“…If the assessments by the cardiologists were not described using proper psychiatric terminology, we interpreted their words used to describe psychiatric symptoms based on the conventional use of psychiatric clinical terms in Japan, and carefully examined medical records to infer the intention of the referral doctors. According to the previous literature [17,18], we classified the psychiatric symptoms described by cardiologists into categories. When we were unable to classify the symptoms into a category that had been previously used in the literature [17,18], we created new categories.…”

Section: Data Collection and Variablesmentioning

confidence: 99%

“…According to the previous literature [17,18], we classified the psychiatric symptoms described by cardiologists into categories. When we were unable to classify the symptoms into a category that had been previously used in the literature [17,18], we created new categories. A symptom was only classified as "delirium" when cardiologists had explicitly written that term in the medical records or referral letter.…”

Section: Data Collection and Variablesmentioning

confidence: 99%

“…It can be difficult for non-psychiatrists to accurately assess various mental disorders in inpatients. The accuracy of non-psychiatrist assessments of psychiatric problems has been reported in elderly patients [17] and in patients with cancer [18]. In these studies, psychiatric symptoms, such as disquietedness or confusion, identified by chief physicians were considered to indicate delirium.…”

Section: Introductionmentioning

confidence: 99%

“…To the best of our knowledge, no previous studies have examined the accuracy of assessments of delirium made by cardiologists. As some previous studies have suggested in other areas, such as in patients with cancer and older populations [17,18], it may be difficult for non-psychiatrists to identify delirium, and this can lead to the prescription of inappropriate medication. The purpose of the current retrospective chart survey was to determine the accuracy of delirium assessments in patients with HF by cardiologists, to identify factors related to the detection of delirium, and to clarify what drug therapies are used for delirium as an initial treatment by cardiologists.…”

Section: Introductionmentioning

confidence: 99%

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The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey

Hayashi

Kobayashi

Matsui

et al. 2020

BioPsychoSocial Med

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Background: Patients with heart failure (HF) accompanied by delirium are at risk of rehospitalization and death, thus early detection and appropriate treatment is imperative. Palliative care for patients with HF is an important issue, particularly for patients who also have delirium. This retrospective study examined the accuracy of delirium assessment by cardiologists treating patients with HF, identified factors related to the detection of delirium, and recorded the initial treatment. Methods: This was a retrospective chart survey of 165 patients with HF referred to a consultation liaison (C-L) service during treatment in the cardiology wards of a general hospital over a 6-year period. Diagnosis of delirium by the C-L psychiatrists was based on DSM-IV-TR. Cases in which cardiologists had stated "delirium" in the medical records were classified as an accurate assessment of delirium (Agreement group). Cases in which cardiologists did not state "delirium" were classified as Disagreement. Results: Among 81 patients with delirium (51 [62.9%] male; 74.7 ± 13.3 years old), the ratio of accurate assessment of delirium by cardiologists was 50.6% (n = 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently (n = 59, 73%), only 33 of these 59 patients (55.9%) were recognized as having delirium by cardiologists. Inappropriate initial treatments were only noted in the Disagreement group. In both groups, most cases were referred to a C-L service without new medication for psychiatric symptoms. Conclusions: An accurate assessment of the delirium of inpatients with HF by cardiologists was found in only around half of all cases. Accurate detection is important to avoid harmful drug administration and to provide appropriate palliative care.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Variablesmentioning

confidence: 99%

Section: Data Collection and Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey

Hayashi

Kobayashi

Matsui

et al. 2020

BioPsychoSocial Med

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Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians

Alsalem

Alharbi²,

Badeghiesh³

et al. 2020

Medicine

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Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC). We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate. Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team. Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians’ knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.

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Variables associated with concordance or discordance for delirium diagnosis between referring and consulting physicians at a Tertiary Hospital in Colombia: Prospective observational study

et al. 2022

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Delirium is an acute state of impaired consciousness and a medical urgency. Its broad range of alterations in mental status make diagnosis challenging. Awareness and accurate provisional diagnosis by nonpsychiatric clinicians are important for prompt management. Because delirium symptoms overlap and mimic other neuropsychiatric conditions, a referral to a consultant psychiatrist is often needed. The aim of this study was to determine the discriminating variables that are associated with concordance or discordance for a DSM-5 delirium diagnosis made by the consultation/liaison (C/L) psychiatrist as compared to the referral diagnosis/reasons given by the referring physicians for inpatients from a Tertiary Hospital in a Latin-American country. Prospective study of a cohort of 399 consecutive patients admitted to any ward of a university hospital in Medellin-Colombia and referred by a specialist physician to the C/L Psychiatry service. Analyses for diagnostic concordance used a nested sample of 140 cases diagnosed with delirium by the psychiatrist. Two multivariate logistic models were run, for delirium diagnosis concordance and discordance between the referring physician and C/L psychiatrist. The referral diagnosis was concordant with that of Psychiatry in 90/140 patients in 64.3%, with 35.7% discordance. Increasing age (OR = 1.024) and internal medicine ward (OR = 3.0) were significantly related (Wald statistic P < .05) to concordance in the multivariate analysis whose model accuracy was 68.6%. Trauma/orthopedics ward (OR = 5.7) and SARS-CoV-2 infection (OR = 3.8) were important contributors to the model fit though not significant. Accuracy of the discordance model was 70.7%, where central nervous system (CNS) disorder (OR = 6.1) and referrals from ICU (OR = 4.9), surgery (OR = 4.6), neurology/neurosurgery (OR = 5.1) and another consultant (OR = 4.7) were significantly related (Wald statistic P < .05), while metabolic/endocrine disorder (OR = 2.7) was important for model fit, but not significant. Concordance for delirium diagnosis was higher from services where education, guidelines and working relationships with C/L Psychiatry could have contributed beneficially whereas, surprisingly, CNS disorders and neurology/neurosurgery services had higher discordance, as well as the ICU. Routine use of brief sensitive delirium assessment tools such as the DDT-Pro could enhance provisional delirium diagnosis.

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Accuracy of oncologist assessments of psychiatric problems in cancer inpatients

Abstract: The accuracy of non-psychiatrist assessments for psychiatric problems in cancer patients differs by presumed diagnosis. Oncologists should consider unrecognized delirium in cancer inpatients who appear depressed or demented.

Cited by 7 publications

References 41 publications

The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey

The accuracy of delirium assessment by cardiologists treating heart failure inpatients: a single center retrospective survey

Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians

Variables associated with concordance or discordance for delirium diagnosis between referring and consulting physicians at a Tertiary Hospital in Colombia: Prospective observational study

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