Palliative Care Providers’ Practices Surrounding Psychological Distress Screening and Treatment: A National Survey

Kozlov, Elissa; Eghan, Claude; Moran, Sheila; Herr, Keela; Reid, M. Carrington

doi:10.1177/1049909117743960

Cited by 18 publications

(12 citation statements)

References 26 publications

(24 reference statements)

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“…48 Further research is needed to ensure use of the Distress Thermometer is integrated within an evidence-based pathway for identification and management of distress. 16,17…”

Section: Discussionmentioning

confidence: 99%

“…There is evidence that the majority of palliative care providers do not use a validated tool to screen for psychological morbidity. 16,17 Clinical guidelines for distress management in cancer populations recommend screening for distress in all patients, followed by clinical diagnostic interview for those who screen positive. [41][42][43] Palliative care guidelines 44 are consistent with this recommendation but do not identify specific examples of tools to be used, or the timing of administration, instead emphasizing, "whenever possible and appropriate, a validated and context-specific assessment tool is used;" 44 p64].…”

Section: Implications For Practicementioning

confidence: 99%

“…It is also worth noting the recommen dation that tools with acceptable sensitivity among patients with high symptom burden are particularly needed. 17 The Distress Thermometer as a one-item measure is quick to administer and unlike other tools used within this setting 45 does not rely on aspects of psychological morbidity that are also common somatic symptoms of illness.…”

Section: Implications For Practicementioning

confidence: 99%

“…13 Clinical guidelines and quality indicators for specialist palliative care 14,15 recommend ongoing assessment of psychological reaction to illness with validated assessment tools. There is however indication that validated tools are not frequently used in specialist palliative care settings, 16,17 with psychological morbidity potentially underreported and undertreated. 18 Ultra-short screening tools ( < 5 items) are attractive to clinicians because of their ease of use, 18 followed by a more lengthy assessment undertaken only for patients reporting clinically significant scores.…”

Section: Introductionmentioning

confidence: 99%

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Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

et al. 2020

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Background: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. Aim: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. Design: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. Setting/Participants: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. Results: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. Conclusions: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.

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“…48 Further research is needed to ensure use of the Distress Thermometer is integrated within an evidence-based pathway for identification and management of distress. 16,17…”

Section: Discussionmentioning

confidence: 99%

Section: Implications For Practicementioning

confidence: 99%

Section: Implications For Practicementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validation of the Distress Thermometer in patients with advanced cancer receiving specialist palliative care in a hospice setting

et al. 2020

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“…Traditional cognitive‐behavioral therapy requires 12 to 20 sessions over as many weeks, but abbreviated therapies can be administered in under 8 sessions . Furthermore, most palliative care teams do not employ a dedicated mental health professional . Assessing the magnitude of psychological symptoms for those nearing end of life may be helpful to demonstrate where specialist support would be most useful.…”

mentioning

confidence: 99%

The Epidemiology of Depressive Symptoms in the Last Year of Life

Kozlov

Dong

Kelley

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVE: Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study's objectives were to document the epidemiology of depressive symptoms in the year prior to death and to assess how the trajectory of depressive symptoms varies by sociodemographic and clinical factors. DESIGN: Observational, cross-sectional, cohort study using the Health and Retirement Study. SETTING: Population-based survey. PARTICIPANTS: A total of 3274 individuals who died within 12 months after assessment. MEASURES: Primary outcome: eight-item Center for Epidemiologic Studies Depression Scale (CESD-8). Covariates included sociodemographics, self-reported illnesses, and activity of daily living (ADL) limitations. RESULTS: Average CESD-8 score increased over the last year of life, with 59.3% screening positive for depression in the last month before death. Depression symptoms increased gradually from 12 to 4 months before death (increase of 0.05 points/month; 95% confidence interval [CI] = 0.01-0.08 points/month) and then escalated from 4 to 1 months before death (increase of 0.29 points/month; 95% CI = 0.16-0.39 points/month). Women, younger adults, and nonwhite adults all demonstrated higher rates of depressive symptoms. Individuals with cancer reported escalating rates of depressive symptoms at the end of life, while individuals with lung disease and ADL impairment demonstrated persistently high rates throughout the year before death. CONCLUSIONS: This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan. J Am Geriatr Soc 68:321-328, 2020.

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