Search

Background Patients in a palliative care trajectory frequently suffer from depression. To distinguish depression from normal sadness, the use of screening instruments could facilitate the diagnostic process. However, in palliative care, screening instruments may not discern physical symptom burden from psychological distress, due to the high number of physical symptoms in palliative patients. Objectives The aim of this study was to explore physical symptom burden and psychological distress in patients with advanced cancer in relation to scores on screening instruments for depression. Methods Patients with advanced cancer were asked to fill out the Beck Depression Inventory ( BDI- II), Beck Depression Inventory Primary Care ( BDI- PC), Hospital Anxiety and Depression Scale ( HADS), and Memorial Symptom Assessment Scale Short Form ( MSAS- SF). The relationship between scores on screening tools for depression and different physical symptom clusters was explored. Results In the sample of 65 patients, screening instruments for depression correlated highly with different somatic symptom clusters. The BDI- II cognitive subscale was the only scale that was not significantly correlated with any of the somatic symptom clusters. Conclusion Screening tools for the detection of depression in patients with advanced cancer may not provide an accurate evaluation of depression. These tools seem to measure physical symptom burden as well, especially when patients suffer from symptoms of the clusters fatigue/anorexia/cachexia, neuropsychology, debility, or pain. In this study, the BDI- II cognitive subscale seems to differentiate best from somatic symptom burden. [ABSTRACT FROM AUTHOR]

Abstract: Background: In low back pain (LBP) treatment and research attention has shifted from a biomedical towards a biopsychosocial approach. Patients’ LBP beliefs and attitudes were found to predict long-term outcome, and recently it has been suggested that the health care providers’ ideas about LBP are also important predictors of treatment behaviour and outcome. Aims: In the present study we examined whether (1) differences in General Practitioners’ (GP) LBP treatment orientation are associated with differences in actual treatment behaviour and (2) whether treatment orientation is related to LBP outcome in patients. Methods: Two hundred twenty two patients consulting their GP with a new episode of LBP were recruited and completed questionnaires on (among others) LBP outcome (graded chronic pain scale) at baseline, during 12 months of follow-up and at the end of the study. Data on treatment were collected from the GPs. The GPs also completed a set of questionnaires on LBP treatment orientation. Associations between measures of treatment orientation, treatment recommendations, treatment behaviour and LBP outcome were analysed. Results: A biomedical treatment orientation was found to be associated with more concern about tissue damage and the effect of physical activity on pain and recovery in vignettes. No associations were found between treatment orientation measures, actual treatment behaviour and LBP outcome. Conclusions: Associations were not found as expected. Still these findings are relevant and may feed a clinically important debate on widely accepted assumptions about the role and influence of health care providers in changing patients’ pain behaviours. [Copyright &y& Elsevier]