Financial threat, hardship and distress predict depression ...
IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)
-
Upload
alex-j-mitchell -
Category
Health & Medicine
-
view
418 -
download
3
description
Transcript of IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)
Alex Mitchell [email protected] Consultant Liaison Psychiatrist, Leicester Royal Infirmary UK
Paul SymondsReader in Clinical Oncology, Leicester Royal Infirmary UK
IPOS2009 – Talk
How Accurate are Cancer Professionals’ Assessments of depression and distress:
A Meta-analysis of Diagnoses by Oncologists & Clinical Nurse Specialists
IPOS2009 – Talk
How Accurate are Cancer Professionals’ Assessments of depression and distress:
A Meta-analysis of Diagnoses by Oncologists & Clinical Nurse Specialists
Individual Lecture 2-24June 2009: 9.00am (Category Communication Skills) Sess 13 Lect 3
BackgroundBackground
Methods to Evaluate Depression
Unassisted Clinician Conventional Scales
Ultra-Short (<5)Short (5-10) Long (10+)Untrained Trained
Implementation Implementation Implementation
Acceptability? Acceptability ? Acceptability ?
Accuracy? Accuracy? Accuracy?
n=226 How=>
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9% Other/Uncertain
2%
Use a QQ15%
ICD10/DSMIV13%
Clinical Skills Alone55%
1,2 or 3 Simple QQ15%
Cancer StaffCurrent Method (n=226)
Psychiatrists
[handout 6]
1,2 or 3 Simple QQ24%
Clinical Skills Alone20%
ICD10/DSMIV24%
Short QQ24%
Long QQ8%
Algorithm26%
Short QQ23%
ICD10/DSMIV0%
Clinical Skills Alone17%
1,2 or 3 Simple QQ34%
Cancer StaffIdeal Method (n=226)
Psychiatrists
Effective?
Validity=>
[handout 6]
Assessing CliniciansAssessing Clinicians
Testing Clinicians vs DTTesting Clinicians vs DT114 ratings from clinical nurse specialists (CNS).
81 individuals (71%) scored above a cut-off of 3 (mild distress)
64 patients (56%) scored above a cut-off of 4 (moderate distress)
37 (32.4%) individuals scores above 5 (severe distress)
[handout 7]
ResultsResultsDT 3v4 (mild, high prevalence)
DT 4v5 (moderate, medium prevalence)
DT 5v6 (severe, low prevalence)
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Post
-test
Pro
babi
lity
Severe Distress CNS+Severe Distress CNS-Baseline ProbabilityMild Distress CNS+Mild Distress CNS-Mod Distress CNS+Mod Distress CNS-
Assessing Clinicians – Meta-AnalysisAssessing Clinicians – Meta-Analysis
Testing Clinicians: A Meta-AnalysisTesting Clinicians: A Meta-AnalysisMethods12 studies reported in 7 publications. Two studies examined
detection of anxiety, 8 broadly defined depression (includes HADS-T), 3 strictly defined depression and 7 broadly defined distress.
9 studies involved medical staff and 2 studies nursing staff. Gold standard tools including GHQ60, GHQ12 HADS-T, HADS-D, Zung and SCID.
The total sample size was 4786 (median 171).
Testing Clinicians: A Meta-AnalysisTesting Clinicians: A Meta-AnalysisResultsAll cancer professionalsSE =39.5% and SP =77.3%.
OncologistsSE =38.1% and SP = 78.6%; a fraction correct of 65.4%.
By comparison nursesSE = 73% and SP = 55.4%; FC = of 60.0%.
When attempting to detect anxietyoncologists managed a SE = 35.7%, SP = 89.0%, FC 81.3%.
Individual Lecture 2-24June 2009: 9.00am (Category Communication Skills) Sess 13 Lect 3
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Pos
t-tes
t Pro
babi
lity
Nurse Positive
Nurse Negative
Baseline Probability
Doctor Postive
Doctor Negative
0.8520.368Nurse
0.7240.458Doctor
NPVPPV
N=10 vs N=2
Cumulative Recognition
=> Combinations
Cumulative Recognition
=> Combinations
Cancer Population
CNS Assessment
Possible case
Depression
Screen #1+ve
n = 200 No Depression
Sp 55%
Se 70%
n = 800
N = 1000
TP = 140
FP = 360Probable Non-Case TN =440
FN = 60
PPV 28% NPV 88%
Screen #1-ve
YieldTP = 140
TN = 440
FN = 60
FP = 360
NPV 88%
PPV 28%
Sp 55%
Se 70%
Cancer Population
CNS Assessment
Possible case
Depression
Screen #1+ve
n = 200 No Depression
Sp 55%
Se 70%
n = 800
N = 1000
TP = 140
FP = 360Probable Non-Case TN =440
FN = 60
PPV 28%
Oncologist Assessment Sp 80%
Sp 40%
NPV 88%
Probable Depression TP = 56
FP = 72Probable Non-Case TN =288
FN = 84
PPV 44% NPV 77%
Screen #1-ve
Screen #2+ve
Screen #2+ve
Cumulative YieldTP = 56
TN = 728
FN = 144
FP = 72
NPV 83%
PPV 44%
Sp 91%
Se 28%
Poster session 3 (25 June 2009)
Poster category 1
(Communication skills) Poster Nr. 18
Credits & Acknowledgments
Elena Baker-Glenn University of NottinghamPaul Symonds Leicester Royal InfirmaryChris Coggan Leicester General HospitalBurt Park University of NottinghamLorraine Granger Leicester Royal InfirmaryMark Zimmerman Brown University, Rhode IslandBrett Thombs McGill University CanadaJames Coyne University of Pennsilvania
For more information www.psycho-oncology.info