Depression is a frequent symptom in palliative care patients but is often not diagnosed. In the U.K., the majority of patients with advanced cancer are referred to a clinical nurse specialist (CNS) whose remit includes the assessment of psychological symptoms and depression. Clinical nurse specialists have a key role in the diagnosis and management of patients with depression and it is important that they have the skills to do so. A postal questionnaire of all U.K. hospital, hospice, and community palliative care clinical nurse specialist teams was carried out to determine how they assessed depression in their patients. The response rate was 40%. Seventy-nine percent of all clinical nurse specialists believed their skills were poor in this area, and 92% felt they required further training. These beliefs were substantiated by the difficulties nurses encountered in assessing depression and by their beliefs regarding antidepressant medication. Clinical nurse specialists have a pivotal role in improving the detection and management of depression in palliative care patients, and require further training in this area.
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References
1.
BarracloughJ.Cancer and Emotion.Chichester: John Wiley & Sons, 1994
2.
MinagawaH., UchitomiY., YamawakiS., IshitaniK.Psychiatric morbidity in terminally ill cancer patients. Cancer1996; 78: 1131–1137.
3.
HopwoodP., StephensR.Depression in patients with lung cancer: prevalence and risk factors derived from quality of life data. J Clin Oncol2000; 18: 893–903.
4.
LanderM., WilsonK., ChochinovH.M.Depression and the dying older patient. Clin Geriatr Med2000; 16: 335–356.
5.
MaguireP., HowellA.Improving the psychological care of cancer patients. In: HouseA., MayouR., MallinsonC. (eds). Psychiatric Aspects of Physical Disease.London: Royal College of Psychiatrists, 1995; pp. 41–54.
6.
HatchB.Assessing depression in primary care. Nurse Pract Forum1992; 3: 220–225.
7.
BottomleyA.Psychosocial problems in cancer care: a brief review of common problems. J Psychiatr Ment Health Nurs1997; 4: 323–331.
8.
GrayR., ParrA., PlummerS., SanfrodT., RitterS., Mundt-LeachB.A national survey of practice nurse Involvement in mental health interventions. J Adv Nurs1999; 30: 901–906.
9.
AdamekM., KaplanM.Caring for depressed and suicidal older patients: a survey of physicians and nurse practitioners. Int J Psychiatry Med2000; 30: 111–125.
10.
ChilversC., DeweyM., FieldingK., GrettonV., MillerP., PalmerB.Antidepressant drugs and generic counselling for treatment of major depression in primary care: randomised trial with patient preference arms. Br Med J2001; 322: 772–775.
11.
Lloyd-WilliamsM., FriedmanT., RuddN.A survey of antidepressant prescribing in hospices. Palliat Med1998; 13: 293–298.
12.
MaguireP.The use of antidepressants in patients with advanced cancer. Support Care Cancer2000; 8: 265–267.
13.
MartinA., JacksonK.Depression in palliative care patients. Hospice J2000; 7: 71–89.
14.
McDonaldM., PassikS., DuganW., RosenfieldB., TheoboldD.Nurses’ recognition of depression in their patients with cancer. Oncol Nurs Forum1999; 26: 593–599.
15.
ProffittC., AugspurgerP., ByrneM.Geriatric depression: a survey of nurses’ knowledge and practices. Issues Ment Health Nurs1996; 17: 123–130.
16.
PassikS., BreitbartW.Depression in patients with pancreatic carcinoma. Cancer1996; 78: 615–626.
17.
SilberfarbP., MaurerL., CroulhamelC.Psychosocial aspects of neoplastic disease: functional status of breast cancer patients during different treatment regimes. Am J Psychiatry1980; 137: 450–455.
18.
HarrisonJ., MaguireP.Influence of age on psychological adjustment to cancer. Psychooncology1995; 4: 33–38.
19.
CaseyP.Depression in the dying: disorder or distress. Prog Palliat Care1993; 2: 1–3.
20.
BrownJ., HenteleffP., BarakatS., RoweC.Is it normal for advanced metastatic cancer ill patients to desire death?Am J Psychiatry1986; 143: 208–211.
21.
ChochinovH., WilsonK., EnnsM., MowchunN., LanderS., LevittM., ClinchJ.Desire for death in the terminal Ill. Am J Psychiatry1995; 152: 118–191.
22.
HallA., A'hearnR., FallowfieldL.Are we using appropriate self report questionnaires for detecting anxiety and depression in women with early breast cancer?Eur J Cancer1999; 35: 79–85.
23.
IbbotsonT., MaguireP., SelbyT., PriestmanT., WallaceL.Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer.1993; 30: 37–40.
24.
PassikS., DuganW., McDonaldM., RosenfieldB., TheobaldD., EdgertonS.Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol1998; 16: 1594–1600.
25.
PassikS., DonaghyK., TheobaldD., LundbergJ., HoltsclawE., DuganW.Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: Implications for designing a training program. J Pain Symptom Manage2000; 19: 329–338.
26.
KellyJ., LehmanL.Assessment of anxiety, depression and suspiciousness in home care setting. Home Healthc Nurse1993; 11: 16–20.
27.
LehmanL., KellyJ.Nursing interventions for anxiety, depression and suspicion in the home care setting. Home Healthc Nurse1993; 11: 35–40.
28.
BadgerT., MishelM., BiocaL., CardeaJ.Depression assessment and management: evaluating a community-based mental health training programme for nurses. Public Heath Nurs1991; 8: 170–175.
29.
JohnsonL., RobertsS.A cognitive model for assessing depression and providing Interventions in cardiac intensive care. Intensive Crit Care Nurs1996; 12: 138–146.
30.
PayneS.Depression in palliative care patients: a literature review. Int J Palliat Nurs1998; 4: 184–191.
