Screening for depression in palliative care patients in general practice and hospital

Depression is highly prevalent in palliative care patients. The European
Association of Palliative Care (EAPC) reports a prevalence of depression up to
58 %. Depression in palliative care patients is associated with lower quality
of life and is a burden for patients and caregivers. Depression also has a
negative influence on the experience of physical symptoms.
The recognition of depressive disorders by physicians is not optimal. The
overlap of depressive symptoms that can also be caused by advanced disease (eg.
fatigue, weight loss), the difficulty distinguishing grief from depression and
a poor communication are factors that can contribute to the difficulty of
diagnosing depression in this specific population. Finally, physicians are
commonly more focused on the physical symptoms than the emotional symptoms.
A self-report questionnaire to screen for depression could facilitate
diagnosing depression. This study aims to determine the validity and
feasibility of the Beck Depression Inventory (BDI-II), the Hospital Anxiety and
Depression Scale (HADS) and a short screening (3 questions) to screen for
depression in palliative care patients.

The main objective of this study is to determine the validity and feasibility
of the Beck Depression Inventory (BDI-II), the Hospital Anxiety and Depression
Scale (HADS) and a short screening (3 questions), as a screening instrument for
the detection of depression in palliative care patients in general practice and
hospital.

Cross-sectional design with a follow-up of 8 weeks.
Palliative care patients are asked to fill out a questionnaire with the Beck
Depression Inventory (BDI-II), the Hospital Anxiety and Depression Scale (HADS)
and a short screening (3 questions). Within two weeks, the patient is asked to
fill out the Beck Depression Inventory Primary Care (7 questions). After 8
weeks the patient is asked once again to fill out a questionnaire with the
BDI-II, the HADS and the short screening.

If the treating physician judges a patient fit to participate in the
questionnaire-research, the patient is asked to participate. The patient
receives information on the research and an invitation to participate, together
with the first questionnaire, which will take approximately 20 minutes to fill
out. If the patient decides to participate and returns the questionnaire;
within two weeks the patient will receive a short questionnair (7 questions),
which takes approximately 5 minutes to fill out.
A sample of the patients (all patients that score above the usual cut-off
points of the screening tools and a random sample of the patients that score
below all usual cut-off points) will be asked to participate in a structured
interview with the researcher. This interview will take approximately 45
minutes.
Eight weeks after the first questionnaire is received, patients will receive
the last questionnaire that will take approximately 10 minutes to fill out.
The filling out of the questionnaires might be tiring for palliative care
patients and it is possible that a patients experiences emotional distress
because of the questionnaires. However, a recent study investigating the
experienced burden of participating in psychosocial research for palliative
care patients shows that most patients that participate are happy to
participate and even experience personal benefit on participating in the
research. (Pessin et al. Burden and benefit of psychosocial research at the end
of life, Palliative Medicine 11 (4), 2008)