Towards Improved Diagnosis and Symptom Management in Palliative Care
Palliative Care, Depression, Assessment Tools, Carnell Scale for Depression in Dementia and Abbreviated Scale.
Depression is very common among people in the advanced stages of a life-limiting condition. Approximately one in six of those receiving palliative care have major depression. Unfortunately depression often goes undiagnosed or untreated. Many life-limiting diseases share symptoms common to depression. Such symptoms may include significant weight loss, fatigue and poor concentration, all key symptoms used to diagnose depression.
This study, a mixed methods approach, set out to review and identify best practices for assessment of cognition and depression in palliative care settings. The study aimed to develop a user-friendly testing procedure that allows for both applicability and efficiency in accurately identifying cognitive and mood disturbances in everyday clinical practice.
Comparison of various assessment tools in palliative care in patients (n=142) against clinical diagnosis made by an experienced psychiatrist revealed one tool in particular performed particularly well. This tool is the Carnell Scale for Depression in Dementia (CSDD). However, the scale was also deemed cumbersome due to the nineteen items which the clinician must rate the patient for which is a very time-consuming process. The research team used the data available to them to narrow down the CSDD to five items. Further research revealed that the amended scale could identify major depression among palliative care in patients with comparable accuracy.
This research has developed a brief and simple to use abbreviated scale to assess for major depression among palliative care patients. The tool can be successfully implemented by palliative care physicians who are often under severe time constraints and who may not have extensive psychiatric training.
Study carried out: Oct 2013 – Oct 2017
Prof David Meagher, Consultant Psychiatrist, Department of Adult Psychiatry, University Hospital Limerick; Prof Karen Ryan, Clinical Associate Professor, UCD; Palliative Medicine Consultant, Mater Misericordiae Hospital & St Francis Hospice; & Clinical Lead for Palliative Care, HSE.
Dr Mas Mohamad and Ms Brid Davis (PhD Scholars).
This research was funded by the Health Research Board (HRB) and All Ireland Institute of Hospice and Palliative Care (AIIHPC) through its Palliative Care Research Network (PCRN).