The present study explores the levels of anxiety and depression experienced by a sample of 44 patients with metastatic breast cancer 1–7 weeks before their death. In addition, relationships were examined between symptomatology (measured by the Rotterdam Symptom Checklist) and anxiety and depression (measured by the Hospital Anxiety and Depression Scale). Results suggested that a high proportion of patients scored in the case range for anxiety (66%) and depression (50%) using the cut‐off scores suggested by the authors. Weak positive correlations between physical symptomatology and anxiety and depression were ascertained using scores from the Rotterdam Symptom Checklist and the Hospital Anxiety and Depression Scale. The results of the present study are discussed in the context of previous research findings and further research avenues are highlighted.
BackgroundThe association between stress and morale among general practitioners (GP) is well documented. However, the impact of GP stress or low morale on patient care is less clear. GPs in the UK now routinely survey patients about the quality of their care including organizational issues and consultation skills and the General Practice Assessment Questionnaire (GPAQ) is widely used for this purpose. We aimed to see if there was a relationship between doctor morale as measured by a validated instrument, the Morale Assessment in General Practice Index (MAGPI) and scores in the GPAQ.MethodsAll GPs in Lothian, Scotland who were collecting GPAQ data were approached and asked to complete the MAGPI. Using an anonymised linkage system, individual scores on the MAGPI were linked to the doctors' GPAQ scores. Levels of association between the scores were determined by calculating rank correlations at the level of the individual doctor. Hypothesised associations between individual MAGPI and GPAQ items were also assessed.Results276 of 475 GPs who were approached agreed to complete a MAGPI questionnaire and successfully collected anonymous GPAQ data from an average of 49.6 patients. There was no significant correlation between the total MAGPI score and the GPAQ communication or enablement scale. There were weak correlations between "control of work" in the MAGPI scale and GPAQ items on waiting times to see doctors (r = 0.24 p < 0.01). Doctors who perceived that their patients viewed them negatively also scored lower on individual communication, accessibility and continuity of care GPAQ items.ConclusionThis study showed no relationship between overall GP morale and patient perception of performance. There was a weak relationship between patients' perceptions ofquality and doctors' beliefs about their workload and whether patients value them. Further research is required to elucidate the complex relationship between workload, morale and patients' perception of care.
This study monitored the prevalence and detection of psychiatric morbidity in 80 women newly diagnosed with metastatic breast cancer from diagnosis of metastatic disease over a 16-month period. Patients were interviewed at home every 8 weeks using the Hospital Anxiety and Depression Scale (HADS) and an interview schedule compiled by the author to monitor contact with members of the multidisciplinary team, demographic details, current treatment and sites of metastatic spread. One way analysis of variance (ANOVA) comparing the mean anxiety and depression scores at each interview demonstrated that there were no statistically significant differences in mood across the eight interviews, though there was a trend over the course of the eight interviews for mean anxiety and depression to decrease. Using the cut off scores suggested by the authors of the HADS, the scores were then categorized into case, borderline and normal. These analyses illustrated the relatively large proportion of patients who fell into the borderline and case ranges for anxiety and/or depression with, for example, 39% of women scoring in the case range for anxiety and 31% for depression at diagnosis of metastatic breast cancer. Detection of these mood problems was extremely low with referral to appropriate services not in evidence. The results of this study are consistent with those of other studies monitoring the psychological needs of women with breast cancer and the detection of mood disturbance. The clinical relevance of the results of the present study are discussed and future research avenues suggested.
In this study of teachers’ beliefs about young people with chronic fatigue syndrome (CFS), Tina Everett and Colette Fulton find that although teachers are very much concerned to give the right sort of support to enable their students to continue their education, there is confusion about the nature, origin and cause of the illness. They recommend that schools are provided with sound scientific and practical information, and that better communication is established between health and education staff for the benefit of students with CFS and their families.
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