OP-11 Screening for depression and anxiety in palliative care inpatients: a quality improvement project
Year: 2025
Type: conference-paper
Abstract: Introduction Depression and anxiety is prevalent in the palliative care population, with recent studies estimating that as many as 25% of patients meet criteria for an anxiety or depressive disorder. However, depression and anxiety in this population is often underdiagnosed and untreated, with evidence showing that this may worsen morbidity and mortality outcomes. Aims The aim of this project was to improve the detection of depression and anxiety in palliative care patients in Hospice inpatient unit (IPU), and facilitate the provision of targeted multidisciplinary support to patients suffering from psychological distress. Methods A retrospective audit of the IPU admission clerking and initial Integrated Palliative care Outcome Scale (IPOS) for patients admitted to the ward was conducted over a one-month period. This identified 54.5% of the inpatient cohort who expressed symptoms of anxiety and/or depression on initial clerking, and 66.7% of the cohort who scored highly in one or more of three key categories on initial IPOS questionnaire: a) Anxiety about illness, b) Feeling at peace, and c) Feeling depressed. Subsequently, the Hospital Anxiety and Depression Scale (HADS) was trialled as a formal screening tool to identify patients who would benefit from a holistic and personalised action plan for their mood, factoring in patients’ psychological, spiritual and social needs. Results 75% patients who scored ’abnormal’ on the HADS had their mood symptoms recognised in the weekly MDT meeting, with a 75% success rate of developing holistic action plans. Conclusion The results of the first cycle of this project demonstrate that there is scope for the implementation of a formal screening tool to identify depression and anxiety in the inpatient palliative care population in order to ameliorate holistic support for these symptoms. Impact Overall, the project raises further questions about the best choice of tool given our multi-lingual and multicultural population. References Austin P, Wiley S, McEvoy P, Archer L. Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. Palliative and Supportive Care 2011;9(4);393–400. doi:10.1017/S1478951511000411 Götze H, Brähler E, Gansera L, Polze N, Köhler N. Psychological distress and quality of life of palliative care patients and their caring relatives during home care. Support Care Cancer 2014;22:2775–82. Holtom N, Barraclough J. Is the hospital anxiety and depression scale (HADS) useful in assessing depression in palliative care? Palliative Medicine 2000;14(3):219–220. Hotopf M, Chidgey J, Addington-Hall J, Ly K. Depression in advanced disease: a systematic review part 1. Prevalence and case finding. Journal of Palliative Medicine 2002;81–97. Irwin SA, Rao S, Bower K, Palica J, Rao SS, Maglione JE, . . . Ferris FD. Psychiatric issues in palliative care: recognition of depression in patients enrolled in hospice care. Journal of Palliative Medicine 2008;11(2):158–163. Lawrie I, Lloyd-Williams M, Taylor F. How do palliative medicine physicians assess and manage depression. Palliative Medicine 2004;18(3):234–8. Le Fevre P, Devereux J, Smith S, Lawrie SM, Cornbleet M. Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the hospital anxiety and depression scale and the general health questionnaire-12. Palliative Medicine 1999;13(5):399–407. Lloyd-Williams M, Shiels C, Dowrick C. The development of the brief edinburgh depression scale (BEDS) to screen for depression in patients with advanced cancer. Journal of Affective Disorders 2007;99(1–3):259–64. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet 2007;370(9590):851–8. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychological Medicine 2010;40(11):1797–810. Rodríguez-Mayoral O, Rodríguez-Ortíz B, Ascencio-Huertas L, Peña-Nieves A, Verástegui E, Allende-Pérez S, Lloyd-Williams M. Validation of the brief edinburgh depression scale (BEDS) in a Mexican population with advanced cancer in a palliative care service. Palliative and Supportive Care 2019;17(4):436–440. Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. Journal of Psychosomatic Medicine 1983;45(4):333–9. WHO. (2024). WHO Definition of Palliative Care. Retrieved September 9th, 2024, from World Health Organization: https://www.who.int/health-topics/palliative-care Wilson K, Chochinov H, Skirko M, Allard P, Chary S, Gagnon P, . . . Clinch J. Depression and anxiety disorders in palliative cancer care. Journal of Pain and Symptom Management 2007;33(2):118–129.
Authors: Juliette Murphy, Rebecca Gardiner, Alice Edwards
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4407284951