Effect of counselling on the psychiatric morbidity associated with mastectomy.

Maguire, Peter; Tait, A; Brooke, Mike; Thomas, Chris; Sellwood, R A

doi:10.1136/bmj.281.6253.1454

Cited by 236 publications

(116 citation statements)

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“…A high level of unmet need for depression treatment has been recently reported (Fallowfield et al, 2001). Of more concern is the observation that similar findings were reported 20 years ago (Maguire et al, 1980). While it is possible that our estimate of unmet treatment needs was artificially increased because patients who had received effective treatment no longer meet the criteria for MDD, this finding has substantial implications for outpatient cancer services.…”

Section: Unmet Treatment Needsupporting

confidence: 55%

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

et al. 2004

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A screening programme designed to identify cases of Major Depressive Disorder (MDD) in patients attending a Regional Cancer Centre outpatient department was established. It comprised two stages: (1) The Hospital Anxiety and Depression Scale (HADS) selfrating questionnaire administered by a touch-screen computer; (2) we interviewed patients with high scores on the HADS (15 or more total score) over the telephone using the depression section of the Structured Clinical Interview for DSMIV (SCID). A large consecutive sample (5613) of oncology clinic attenders was screened, and practical difficulties in the screening process were identified. The estimated prevalence of major depressive disorder (MDD) in the sample surveyed was approximately 8% (7.8%; 95% confidence intervals 6.9 -8.5%). We assessed a consecutive series of 150 patients identified as having MDD to determine how many had received evidence-based treatment for MDD. Only half had discussed their low mood with their general practitioner, only onethird had been prescribed any antidepressant medication, and very few had taken a therapeutic dose for an adequate period. Very few had received psychological treatment or had been referred to mental health services. Most were receiving no potentially effective therapy.

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Section: Unmet Treatment Needsupporting

confidence: 55%

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

et al. 2004

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“…Five per cent (5%) of both unaffected and affected women were clinically depressed and 8% of unaffected and 16% of affected women were 'borderline' clinically depressed. These results are not dissimilar to others reported for affected and unaffected women (Maguire et al, 1980;Meiser et al, 2000). Compared to the normal population, levels of psychological morbidity were not notably high for unaffected women, but anxiety was certainly higher in affected women and if probable cases are included, rates of clinically significant depression were also higher.…”

Section: Baseline Characteristicscontrasting

confidence: 50%

Tailoring communication in consultations with women from high risk breast cancer families

et al. 2002

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This multicentre study examined the influence of patient demographic, disease status and psychological variables on clinical geneticists/genetic counsellors (consultants) behaviours in initial consultations with women from high-risk breast cancer families. One hundred and fifty-eight women completed a pre-clinic self-report questionnaire. The consultations were audiotaped, transcribed verbatim and coded. Consultants did not vary their behaviour according to women's expectations. However, significantly more aspects of genetic testing were discussed with women who were affected with breast cancer (P50.001), screening and management with unaffected women (P=0.01) and breast cancer prevention with younger women (P=0.01). Prophylactic mastectomy was discussed more frequently with women with medical and allied health training (P=0.02), and prophylactic oophorectomy with women affected with breast cancer (P=0.03), those in non-professional occupations (P=0.04) and with a family history of breast and ovarian cancer (P50.001). Consultants used significantly more behaviours to facilitate understanding with women who were in non-professional occupations (P=0.04); facilitated active patient involvement more with women affected with breast cancer (P50.001) and used more supportive and counselling behaviours with affected women (P=0.02). This study showed that patient demographics were more likely to predict consultants' communication behaviours than the woman's psychological status. Methods to facilitate assessment of psychological morbidity are needed to allow more tailored communication. Previous research has documented consultants' reports of the cancer genetic services typically provided to women from high-risk breast cancer families. These include cancer risk assessment and education, facilitation of genetic testing, pre-and post-test counselling, provision of personally tailored cancer risk management recommendations, and psychosocial counselling and support services (NH and MRC, 1999).A recent survey of Australian clinical geneticists and genetic counsellors identified the provision of individualised care as the single most important goal of genetic counselling (Lobb et al, 2001). These consultants emphasised the variability in women's current levels of expectations and needs when they attend genetic counselling and the importance of tailoring communication accordingly.Studies that have examined levels of breast cancer genetics knowledge among women with a family history of breast cancer (Lerman et al, 1996Hughes et al, 1997;Wonderlick and Fine, 1997;Cull et al, 1998;Bluman et al, 1999;Donovan and Tucker, 2000) have found wide variation in knowledge about many facets of genetic testing, including the cancer risks associated with different genes and different mutations and the effectiveness of interventions, for example screening, chemoprevention, or surgery for reducing risk (Geller et al, 1997;Audrain et al, 1998;Bluman et al, 1999).Similarly, there is wide variation in the accuracy of women's perceptions of their li...

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“…Only 22% of patients with psychological problems following mastectomy are recognised by those concerned with their aftercare (Maguire et al, 1980). However, Maguire found that specialist nurses trained to detect such problems, can identify up to 80% of patients with depression or an anxiety state.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians treating women with advanced breast cancer have become increasingly concerned about their quality of life (Baum et al, 1980;Bell et al, 1985;Brinkely, 1985;Coates et al, 1987;Gough et al, 1983;Tannock et al, 1988), yet, the recognition of psychological distress is handicapped by patients' unwillingness to disclose any emotional problems and doctors' and nurses' reluctance to enquire (Maguire et al, 1980). Ways of improving the identification of psychological morbidity need to be found and a self-assessment approach warrants evaluation.…”

mentioning

confidence: 99%

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires

Hopwood

Howell²,

Maguire³

1991

Br J Cancer

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Eighty-one patients with advanced breast cancer completed the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL) to determine how well these questionnaires identified patients suffering from an anxiety state or depressive illness, compared with an independent interview by a psychiatrist who used the Clinical Interview Schedule. A threshold score was defined for each questionnaire which gave the optimal sensitivity and specificity. Seventy-five per cent of patients were correctly identified as suffering from an affective disorder by both the Rotterdam Symptom Checklist and by the Hospital Anxiety and Depression Scale. Twenty-one per cent of 'normal' patients were misclassified by the Rotterdam Checklist and 26% by the Hospital Anxiety and Depression Scale. When the HADs anxiety and depression subscales were analysed separately, the performance of the anxiety items was superior to that of the depression items. Both questionnaires were found to have good predictive value and could be used in patients with advanced cancer to help screen out those with an affective disorder.

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Effect of counselling on the psychiatric morbidity associated with mastectomy.

Cited by 236 publications

References 4 publications

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

Major depression in outpatients attending a regional cancer centre: screening and unmet treatment needs

Tailoring communication in consultations with women from high risk breast cancer families

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires

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