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BackgroundHealth care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection.Methods201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data.ResultsFor individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms.ConclusionsThe results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.

ObjectiveTo compare two perspective taking strategies on (i) clinicians’ ability to accurately identify negative thoughts and feelings of parents of children with cancer, and (ii) clinician distress.MethodsSixty-three hematology-oncology professionals and nursing students watched a video featuring parents of children with cancer. Participants were randomly assigned to one of two groups. In the imagine-self group, they were instructed to imagine the feelings and life consequences which they would experience if they were in the parents’ position. In the imagine-other group, they were instructed to imagine the feelings and life consequences experienced by the parents. Parent-clinician agreement on thoughts/feelings was evaluated (standard stimulus paradigm). Clinician distress was also assessed.ResultsThe intervention was effective in manipulating perspective type. The groups did not significantly differ on parent-clinician agreement. Concentrating on personal feelings (imagine-self strategy) did predict lower agreement when controlling for trait empathy. Clinician distress was higher in the imagine-self group.ConclusionAlthough the link between perspective type and detection of distress remains unclear, the results suggest that clinicians who highly focus on their own feelings tend to be less accurate on parental distress and experience more distress themselves.Practice implicationsThis research could potentially improve communication training and burnout prevention.

This study of 152 community adults examined whether perfectionism interacts with daily perceived control to predict depressive and anxious symptoms over 4 years. Participants completed measures of higher-order perfectionism dimensions [self-critical (SC), personal standards (PS)] and neuroticism at time 1, daily diaries for 14 consecutive days to assess perceived control over most bothersome events at time 2 three years later, and measures of depressive and anxious symptoms at time 1, time 2, and time 3 four years after baseline. Hierarchical regression analyses of moderator effects demonstrated that individuals with higher SC perfectionism at time 1 and lower perceived control across daily stressors at time 2 had higher levels of depressive symptoms at time 3 than others, adjusting for the effects of time 1 and time 2 depressive and anxious symptoms. Higher SC perfectionism also interacted with lower perceived control to predict time 3 anxious symptoms. PS perfectionism and neuroticism did not interact with perceived control to predict time 3 depressive or anxious symptoms. These findings highlight the importance of addressing cognitive appraisals of one's control over handling daily stressors for the prevention and treatment of depressive and anxious symptoms in individuals with higher SC perfectionism. Public Significance StatementThis study demonstrates that individuals with higher self-critical perfectionism are vulnerable to depressive and anxious symptoms over the longer-term when these individuals have lower perceived control over daily stressors. The findings highlight the importance of considering self-critical perfectionism and daily perceived control in the prevention and treatment of depression and anxiety.