Depression in palliative care patients: a survey of assessment and treatment practices of Australian and New Zealand palliative care specialists

Abstract

Objective. To explore the practices of members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) in assessing and treating depression in palliative care patients.Methods. Semistructured questionnaires were forwarded to ANZSPM members in consecutive mail-outs to survey diagnostic and treatment practices for depression.Results. The response rate was 62.3%. The median prevalence of depression, as perceived by respondents, in the present respondent patient populations was 20% (range 0%-90%); 57.1% of respondents always assessed for depression, whereas 42.9% assessed for depression sometimes. The majority (98.9%) of respondents relied on clinical interviews to assess depression; non-somatic symptoms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria were more useful than somatic symptoms. The depression screening tools most frequently used were one-and twoitem questions. Pharmacological and non-pharmacological methods were used to treat depression, with selective serotonin reuptake inhibitors the most frequently prescribed medications. Psycho-educational and supportive counselling were the most frequently used non-pharmacological interventions. Nominated measures to augment depression management included improving access to psychiatry, psychology and other allied health services, the development of a screening tool specific to palliative care patients and associated guidelines for depression management.Conclusions. This is the first Australasian study to explore the practice of medical practitioners regarding depression in palliative patients. Incorporation of screening tool questions into palliative care assessment interviews may warrant future research.What is known about the topic? Depression in palliative care patients has a negative impact on quality of life; however, little is known about how Australasian palliative care medical practitioners manage depression in this patient population. What does this paper add? To the researchers' knowledge, this is the first Australasian study that explores the practices of local palliative care specialists in the management of depression in palliative patients. What are the implications for practitioners? Overall management of depression in palliative care populations by Australasian practitioners is similar to that of their European colleagues. Consensus is that for assessment of depression in palliative patients, non-somatic symptoms of DSM-IV criteria are more useful than somatic symptoms. Practitioners report the need for improved access to psychiatric, psychological and other support services, for a palliative care-specific depression screening tool and for depression management guidelines applicable to palliative care patients.

Clinical prediction rules in practice: review of clinical guidelines and survey of GPs

“…[91][92][93][94] To the author's knowledge this is the first large survey to compare the uptake of CPRs across multiple clinical domains and to relate this to a systematic evaluation of guideline recommendations.…”

Espiritualidad en atención paliativa: Evidencias sobre la intervención con counselling

“…De esta forma, el counselling, que ya en estudios previos se ha mostrado como una herramienta clave para atender a las necesidades emocionales de los pacientes (Breitbart et al 2010;Breitbart et al, 2015 ;Breitbart et al, 2012;Gysels y Higginson, 2004;National Comprehensive Cancer Network, 1999;Newell et al, 2002;Porche et al, 2014), tal y como reconocen distintas organizaciones internacionales (National Comprehensive Cancer Network, 2013;OMS, 2004), se revela también como una psicoterapia óptima cuando el objetivo es atender a las necesidades y los recursos espirituales de los pacientes. A pesar de que ya existen algunos estudios previos en este campo (Rudilla et al, 2015), estos se habían limitado a pacientes de unidades de atención domiciliaria, siendo este el primero en que se ofrece evidencia en una muestra de carácter más general.…”

Clinically Significant Depressive Symptoms Are Prevalent in People With Extremely Short Prognoses—A Systematic Review

“…20,48,65e68 There is intrinsic difficulty in assessing depressive symptoms in individuals whose advanced life-limiting illnesses might mimic depressive symptoms, as well as challenges in providing interventions likely to be effective in time. 1,26 Further barriers to suboptimal recognition, assessment and management include: clinicians' fear of distressing patients, especially given the stigma associated with psychiatric diagnoses; 3,69 lack of awareness and skills to detect and manage depression; 20,68,70e75 perceived lack of resources such as time, 20,68,76 acceptable assessment tools and access to mental health services; 20,69,77e82 beliefs that depression is ''normal''; 69,76 and that screening and interventions are likely to be futile in this context. 70,71,73,83 It is possible that addressing these barriers might lead to an earlier detection and management of depressive symptoms in people with advanced life-limiting illnesses.…”

“…2,3,11e18 The recognition, assessment, and management of depressive symptoms are even more challenging in the subset of the palliative population who are in the last days to weeks of life. 19,20 This period is usually characterized by an increasing dependence on others for care, increasing symptom burden, and declining functional scores indicative of one month or less of median survival. 19,21 These include: Karnofsky Performance Scale (KPS) # 40, Eastern Cooperative Oncology Group (ECOG) 4, and Palliative Performance Scale # 50.…”

“…25 Therefore, some clinicians feel a sense of futility in assessing and managing depressive symptoms of these individuals. 20 As this subset of the palliative population with extremely short prognoses and clinically significant depressive symptoms has specific challenges and needs, it is important to define its prevalence. Previous systematic reviews of the prevalence of depressive symptoms in the palliative care and oncology settings did not explicitly examine prevalence in people with extremely short prognoses.…”