Detecting and Managing Depressed Patients: Palliative Care Nurses' Self-Efficacy and Perceived Barriers to Care

Abstract

Background: Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process. Methods: To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia. Results: A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief. Conclusion: These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

Palliative Medicine Practitioners' Views on the Concept of Depression in the Palliative Care Setting

“…The lack of specificity in the language used to convey depression, the emotionally evocative nature of the EOL, and the overt similarities between depression and sadness are relevant to this conceptual challenge. The difficulty of differentiating between depression and sadness is consistent with earlier studies in the palliative care setting [17][18][19][20] and is salient, given that depression was almost unequivocally considered by participants in this study to be distinct from grief. This suggests a division between the intellectual clarity of concepts and clinical reality, which resonates with observations in the literature of the tension that arises from negotiating between categorical and dimensional concepts of illness.…”

“…15,16 Health professionals have reported difficulties with assessing and managing depression in the palliative care setting. [17][18][19][20] In particular, the distinction between depression and sadness or grief has been reported as challenging by family physicians, 20 palliative medicine physicians, 17 nurses, 18 and professional carers. 19 In a U.K. survey, palliative medicine physicians reported using an assortment of screening methods to assess for depression and endorsed different symptoms as useful for this purpose, 17 whereas general practitioners in the Netherlands emphasized clinical judgement of contextual factors in their assessment.…”

Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients

“…Many health care personnel believe they do not have the skills to assess and recognize depression. [38] Complicating this further is the common misconception among patients and health care personnel that the other party should initiate discussions about psychological issues. [39] Consequently, a considerable under-treatment in this patient group has been documented.…”

The Ethics of Prioritizing Access to Palliative Care: A Qualitative Study

“…11 A series of reasons may underlie this implicit preference, including the perceived time taken to address nonphysical symptoms, 12 the health practitioners' confidence in addressing certain areas of care, 11 and the overt and therefore confronting nature of some physical symptoms compared to sometimes less demonstrably overt psychological and existential suffering. 13 It is unsurprising that there are clinician values-professional and personal-which underlie decisions assigning urgency to patients requiring palliative care and which play an important role in addition to the particular needs of the patients themselves. These values are evident in the influence of relationships with colleagues, with the systems of care and the patients and families themselves.…”