Nurse Specialist Assessment and Management of Palliative Care Patients who are Depressed—a Study of Perceptions and Attitudes

Abstract

Depression is a frequent symptom in palliative care patients but is often not diagnosed. In the U.K., the majority of patients with advanced cancer are referred to a clinical nurse specialist (CNS) whose remit includes the assessment of psychological symptoms and depression. Clinical nurse specialists have a key role in the diagnosis and management of patients with depression and it is important that they have the skills to do so. A postal questionnaire of all U.K. hospital, hospice, and community palliative care clinical nurse specialist teams was carried out to determine how they assessed depression in their patients. The response rate was 40%. Seventy-nine percent of all clinical nurse specialists believed their skills were poor in this area, and 92% felt they required further training. These beliefs were substantiated by the difficulties nurses encountered in assessing depression and by their beliefs regarding antidepressant medication. Clinical nurse specialists have a pivotal role in improving the detection and management of depression in palliative care patients, and require further training in this area.

Implantation du dépistage de la détresse par des intervenants pivots en oncologie

“…Other studies have shown that even though health professionals may use such validated tools, screening for distress was, most of the time, performed in an unsystematic way, without using any screening tools in some cases [21,24]. While some oncology nurses do screen patients' distress and assess needs in their routine assessment, they generally report doing it informally; many report a preference for using their clinical judgment over screening and needs assessment tools [3,20,24].…”

“…However, some reported that nurses may also be concerned by the burden that Screening for Distress tools may add in terms of workload and time consumption [18], as well as by the lack of knowledge and training they received on Screening for Distress [3,21,24]. Other barriers reported in the literature include the lack of an intimate space to perform Screening for Distress with the patient [3], cancer patients' difficulties in understanding or completing the Screening for Distress questionnaire [5,31], as well as poor interest or collaboration from other oncology team members and other organizational barriers [21].…”

Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home

“…Depression and anxiety in palliative care patients has been underdiagnosed, underreported by medical staff, and undertreated (Lloyd-Williams & Payne, 2002;Kelly et al, 2006;Irwin et al, 2008). It has been pointed out that palliative care patients can find it difficult to express intense negative feelings to their medical providers (Mystakidou et al, 2009).…”

Managing depression in patients with vision impairment: A descriptive study of practitioners' beliefs and confidence

“…Depression is often difficult to identify in primary care settings especially for patients with chronic illness [16]. Recently, emphasis has been placed on health‐care providers who work with patient groups at risk of depression in settings such as aged care [17], oncology [18] and palliative care [19]. Research from both primary and tertiary care settings has indicated that two important barriers to depression management are practitioners' attitudes to depression and their low confidence in recognising and assessing depression [20,21].…”