Julie Ann Robinson

Identifying palliative care patients with symptoms of depression: an algorithm

Introduction: Even though depression has serious and wide-ranging effects on outcomes in palliative care, errors in the identification of depressed patients are common. Objectives: To examine the clinical validity of widely publicised one-and two-question screening tools for depression in two palliative care settings. Also, to examine the construct validity and acceptability of a new empirically derived algorithm. Method: Participants were Australian palliative care patients in an inpatient hospice (n–22) or the community (n –69). Patients completed an unstructured interview about their feelings, questions relevant to three reference standards, two screening questions for depression and questions about the acceptability of the screening questions. Results: The clinical validity of the one-and two-question screening tools did not generalise across the two care settings. In contrast, the algorithm met stringent criteria for clinical validity for two reference standards in both settings. The algorithm also selectively identified patients whose unstructured interviews referred to themes consistent with depression. The algorithm includes potentially sensitive questions about anhedonia and depressed affect. However, almost all patients and staff reported that asking such questions soon after referral was acceptable. Conclusions:A four-question algorithm designed to identify patients who warrant follow-up for depression showed clinical validity, generalizability and construct validity, and the content was acceptable to patients and clinicians.

The relationship between syntactic awareness and reading performance

This study was designed to examine the relationship between syntactic awareness and reading performance. A major concern was to provide an estimate of the effect of syntactic training that was not confounded with training that focused on semantic features of words. The training exercises used in the study focused on all levels of syntactic awareness in order that the effect of such training could be assessed on students’ performance on tasks that tapped each of the levels. Results of this study showed that syntactic awareness could be improved through training. The effect was stable, being apparent at the two post-test times. However, no evidence was found for a systematic effect of improved syntactic awareness on reading ability. Moreover, syntactic training did not show any greater effect than no treatment or semantic training on children’s grammatic comprehension, their ability to use fix-up strategies, or on their general reading ability score. Training had a different impact on the accuracy of oral reading for the syntactic and semantic training groups. Thus, in terms of the developmental sequence of syntactic awareness proposed by Gombert (1992), children trained in the cloze procedure improved at the two highest levels, whilst showing neither a corresponding change in the lower levels of awareness, nor improved functional reading performance.

The geriatric depression scale in palliative care.

OBJECTIVEnThis research examined the psychometric properties of previously published short forms of the Geriatric Depression Scale (GDS) in patients receiving palliative care. It also uses the full form of the GDS to examine the prevalence of nonsomatic symptoms of depression in palliative patients.nnnMETHODnParticipants were 84 patients with advanced cancer attending palliative care outpatient clinics. Scores for short forms of the GDS were derived from administering the original 30-item scale. Patients also completed the single item numerical analogue scale for depression from the Edmonton Symptom Assessment System and parallel numerical analogue scales for will-to-live and hope. A subset of the sample completed the measures twice. Short forms were judged on the extent to which they captured information gained from the full scale and their internal consistency, test-retest reliability, convergent and concurrent validity, and their distribution of scores.nnnRESULTSnOverall, five short forms showed good psychometric properties at both visits. Two of these forms were very brief. Some nonsomatic symptoms assessed on the full GDS were reported with high frequency. However, few individuals reported a large number of symptoms. At both visits, patients identified as likely to have severe depression gave different responses from other patients on most items on the GDS-30.nnnSIGNIFICANCE OF RESULTSnSeveral short forms of the GDS may be appropriate for use in palliative care. Patients identified as likely to have severe depression showed many of the same symptoms that characterise depression in other geriatric populations.

Preparing for Year 12 examinations: Predictors of psychological distress and sleep

This study examined the influence of protective factors on psychological distress and sleep among Year 12 students 1 month prior to their externally assessed examinations. The sample included 195 Year 12 students who were to sit for at least one examination. Students completed the Adolescent Resilience Questionnaire, a measure of subjective stress, the Depression Anxiety and Stress Scalesxa0–xa021, and measures of sleep. A sizeable minority of students reported high levels of subjective stress, severe symptoms of depression, anxiety and stress, and very inadequate sleep. Freedom from negative cognitions was the factor most strongly associated with protection from psychological distress. None of the factors protected against inadequate sleep. Results showed few gender differences. The findings validate popular concern about the wellbeing of Year 12 students. They also confirm that protective factors do not provide equal protection for all individuals against all adverse outcomes.

End-Stage Kidney Disease A Survey of Recent Research to Support a Palliative Approach

This survey examines the quantity, quality, and accessibility of recent research that contributes to the evidence-based implementation of a palliative approach to end-stage kidney disease (ESKD). An electronic search identified published articles (between September2009 and August 2011) relevant to adults with ESKD (n = 1628). Few articles (n = 136) referred to key themes in a palliative approach to care: life-limiting illness, holistic care, and unit of care. Most of the relevant empirical articles used designs that did not allow a causal variable to be identified, and evaluations of interventions were rare. The literature was dispersed and often in journals unlikely to be regularly accessed by renal clinicians. Literature supporting the implementation of a full evidence-based palliative approach to ESKD is expanding but remains limited and is difficult to identify and access.

Mindfulness and integrative self-knowledge: Relationships with health-related variables

This study examined how mindfulness and integrative self-knowledge were related to health-related issues. Men in general population (n = 103) and coronary heart disease samples (n = 101) completed the Mindful Attention Awareness Scale, the Integrative Self-knowledge Scale, the Type 2 subscale of the Interpersonal Reactions Inventory, the Perceived Stress Scale, and the Anxiety and Depression Scales. In both samples, there was a moderate positive correlation between mindfulness and integrative self-knowledge and they were negatively correlated with all health-related variables. However, only integrative self-knowledge explained independent variance in health-related variables. Specifically, in both samples, the relationship between mindfulness and health-related variables was mediated by integrative self-knowledge. Mindfulness and integrative self-knowledge are related domains of self-awareness that are associated with a range of health-related variables. These relationships are robust across samples drawn from general population and patients with coronary heart disease. The finding that integrative self-knowledge explained additional variance in the health-related variables after the contribution of mindfulness had been accounted for suggests that reflective self-awareness in integrative self-knowledge may make a unique contribution to the explanation of individual differences in health variables.

Do palliative patients and carers agree about patients' psychological functioning?

OBJECTIVEnPalliative care clinicians and researchers often seek information about patients from informants. This research examines the extent of agreement between information from patients and family caregivers who were asked to serve as collateral sources of information about the patient.nnnMETHODnSixty-six patients with advanced cancer and their family caregivers participated in the study. Two measurement contexts were examined: Direct observation of patients cognitive performance (Mini-Mental State Examination) was compared with carers subjective reports about patients everyday cognition (Cognitive Decline subscale of the Psychogeriatric Assessment Scale), and subjective reports about patient depression were compared between patients and carers who completed parallel forms of the same scale (Geriatric Depression Scale and Geriatric Depression Scale-Collateral Source, respectively). The relationship between patient-completed and carer-completed measures was examined in four ways: the correlation between total scores in the sample, agreement about the prevalence of impaired functioning and of specific symptoms in the sample, agreement concerning whether particular patients showed impaired functioning, and agreement about the presence or absence of a specific symptom for a particular patient.nnnRESULTSnAlthough most measures of agreement showed that information provided by patients and carers was related, the magnitude of discrepancies was substantial.nnnSIGNIFICANCE OF RESULTSnThere was no empirical justification for substituting information from a collateral source for information provided by the patient for any of the measures of agreement for either cognition or depression. The use of information from collateral sources is most appropriate when information from the patient is likely to be incomplete or inaccurate, when insight into caregivers needs or understanding is sought, and when using a multi-informant approach to assessment.

Estimating survival in patients with cancer receiving palliative care: is analysis of body composition using bioimpedance helpful?

BACKGROUNDnThis research investigated whether bioimpedance spectroscopy (BIS) has the potential to improve prognostication in an outpatient clinic for patients with cancer receiving palliative care.nnnMETHODSnSurvival time, and BIS measures of basal metabolic rate and 11 body composition parameters (extracellular fluid [ECF], intracellular fluid [ICF], ratio of ECF to ICF, fluid in trunk and each arm and leg, protein mass, mineral mass, and percent body fat) were recorded for 84 oncology patients.nnnRESULTSnNone of the BIS measures showed a linear association with survival time. However, threshold values associated with short survival were identified for basal metabolic rate and 6 of the body composition measures related to fluid (ECF, ratio of ECF to ICF, fluid in right and left arms, and right and left legs). In addition, almost all patients who died within 6 weeks of assessment reached the threshold values for ECF and/or ECF:ICF ratio.nnnCONCLUSIONnResults confirm that elevated metabolic rate and accumulation of body fluid are indicators of a poor prognosis in patients with cancer receiving palliative care. Because BIS is simple for clinicians to use, is noninvasive, and allows early detection of these parameters, it has the potential to improve prognostication.

No Place Like Home: Resilience Among Adolescent Refugees Resettled in Australia

There is nothing that brings out genuine human endeavour and courage more than the refugee experience. There is nothing like having to cling to every bare breath, to see life reduced to a scarce trickle… Very rarely do we get to see human nature stripped of all that it depends on to learn that human nature is itself enough.