How do palliative medicine physicians assess and manage depression

Abstract

Depression is a significant symptom for approximately 25% of palliative care patients, but is frequently unrecognized and untreated. This study was carried out to determine how senior doctors working in palliative medicine in the UK assessed and managed depression in their patients. A questionnaire was sent to all palliative care units with a designated consultant or medical director. Questions were asked about assessment and management of depression (pharmacological and nonpharmacological); difficulties encountered, qualifications and current post. The response rate was 63%; two-thirds (90) of respondents were consultants and a further 21 medical directors. The majority (73%) routinely assessed for depression with 27% using the Hospital Anxiety and Depression (HAD) Scale and 10% asking the patient 'are you depressed'? The most frequently prescribed medication was SSRI (80%). Less than 6% prescribed psychostimulants. Respondents reported difficulties with the assessment and management of depression which mainly focused on distinguishing symptoms of depression from sadness and whether it was appropriate to treat patients when life expectancy was short. Difficulties were identified in accessing psychiatric input by 47%. Depression is identified as being a difficult symptom to manage by many senior palliative care physicians in the UK and suggestions are made as to how some of theses issues can be addressed.

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

“…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.…”

Psychological Services in Hospices in the UK and Republic of Ireland

“…2 Depression has been identified as being a difficult problem to manage by palliative care physicians in the UK, and access to appropriate psychiatry services described as 'poor and uncoordinated.' 3 Liaison psychiatry services in the UK are expanding but continue to fall well short of the recommendations agreed between various Royal Colleges. 4 The National Institute of Clinical Excellence (NICE) recently published guidelines on supportive and palliative care for adults with cancer.…”

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

“…27 However, it should be noted that in the present study two-thirds of those stating they use a clinical interview only also stated they use a screening tool, usually one-and two-item questions. A possible explanation is that respondents may not recognise the one-and two-item questions as validated screening tools, simply considering them an integral part of their clinical interview.…”

“…Once a diagnosis of depression is made, ANZSPM clinicians, similar to those in the UK 27 and other countries, 31 prefer to treat with both pharmacological and non-pharmacological interventions.…”