Elisabet Wasteson

Depression assessment and classification in palliative cancer patients: a systematic literature review

The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a diagnostic system. There were in total few case definitions of depression. Among these, the classifications were in general based on cut-off scores (77%) and not according to diagnostic systems. The full range of the DSM-IV diagnostic criteria was seldom assessed, i.e. less than one-third of the assessments in the review took into account the duration of symptoms and 18% assessed consequences and impact upon patient functioning. A diversity of assessment methods had been used. Few studies classified depression by referring to a diagnostic system or by using cut-off scores. Evidently, there is a need for a consensus on how to assess and conceptualize depression and related conditions in palliative care.

The detection of depression in palliative care

Purpose of reviewDepression is prevalent in patients receiving palliative care. Though effective management strategies exist, depression is often not recognised and, therefore, not treated. This review will assess recent research on the detection of depression in palliative care and recommend directions for future research. Recent findingsScreening is moderately effective in detecting depression in palliative care. It successfully excludes patients without depression, but is less effective in confirming ‘caseness’. Clinicians prefer ultra-short screening methods consisting of one or two simple questions, but there is still uncertainty about which tool is optimal. Screening should supplement not substitute comprehensive clinical evaluation. Case-definitions of depression seldom take into account the duration of symptoms or their impact on functioning. SummaryThe ability to detect cases of depressive disorder may be less important than the ability to detect depressive symptoms remediable to treatment. This is reflected in the recent interest in conceptualising and detecting psychological distress. Evidence-based guidelines on the detection and management of depression in palliative care are needed to help standardise practice and improve patient outcomes.

Relevance of philosophy of life and optimism for psychological distress among individuals in a stage where death is approaching

The purpose was to investigate the relevance of philosophy of life as well as optimism for the psychological distress among Swedish individuals in a stage where death is approaching. Sixty-nine persons were included; of these were 42 patients newly diagnosed with advanced gastrointestinal cancer and 26 were partners to these patients. The participants’ philosophy of life was studied through a semi-structured interview. The interview statements were subjected to content analysis. Optimism was measured by the Life Orientation Test and psychological distress by the Hospitality and Depression Scale. The results showed that optimistic respondents had less psychological distress. Two aspects of philosophy of life had relevance for such distress. These were wondering about why the cancer had occurred and having a feeling of being able to live a good life having or living near a person with advanced cancer. In conclusion, the above-mentioned aspects of philosophy of life as well as optimism have relevance for psychological distress among these individuals, which stress the importance that health-care staff address both patients’ and their partners’ concerns about their philosophy of life.

Case-based reasoning for assessment and diagnosis of depression in palliative care

The goal of the research presented is to create a computational framework and system architecture for clinical decision support in palliative care. The application focused is the classification of depression. The method under investigation is case-based reasoning, motivated by the complexity of the domain and a lack of generalized principles of sufficient coverage and strength for diagnosis and treatment. A system architecture is described and exemplified through an implemented prototype. The outcome of the research so far is a system that captures the properties intended, and for which a clinical test set-up has been defined.