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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., (© 2012 The Authors Pain Practice © 2012 World Institute of Pain.)

Background: Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods., Aim: To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from cardiovascular disease, cancer or COPD, in a sample of primary care patients., Design and Setting: A historic cohort study, using a 20-year period registration database of medical records in four Dutch general practices (a dynamic population based on the Continuous Morbidity Registration database)., Method: Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used., Results: In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%., Conclusion: The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general practice. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general practice is recommended to improve the diagnosis and treatment of mood disorders in patients in the last phase of life.

Purpose: Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients., Methods: We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti., Results: In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care., Conclusions: Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.

Background: Facing a terminal illness can be highly stressful and palliative care patients frequently suffer from mood symptoms. The focus of health care is often on treating symptoms whereas health-promoting factors receive less attention. The aim of this study was to explore the views of palliative care patients on resources and ways of coping that help them prevent or manage mood symptoms. Methods: A pilot qualitative study was performed through face-to-face semi-structured interviews with fifteen ambulant patients with advanced cancer. The interviews were transcribed verbatim and qualitative analysis was performed independently by two researchers, according to the principle of constant comparative analysis. Results: Patients reported on attitudes and specific coping strategies that they found helpful, as well as aspects of their life narrative and spirituality. Resources were found in meaningful contacts with family and friends and in personal attention of professional medical caregivers for their wellbeing. Conclusions: We conclude that palliative care patients could identify resources to cope with mood symptoms in the context of their unique life. In helping patients to identify the personal resources that are accessible and available in their specific context, patient autonomy in enhancing resilience could be increased. [ABSTRACT FROM AUTHOR]

Abstract: Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients. [Copyright &y& Elsevier]