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Expert opinion on detecting and treating depression in palliative care A Delphi study.doc

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Expert opinion on detecting and treating depression in palliative care A Delphi study

Rayneretal.BMCPalliativeCare2011,10:10 /1472-684X/10/10 RESEARCH ARTICLE OpenAccess Expertopinionondetectingandtreating depressioninpalliativecare:ADelphistudy LaurenRayner1,2*,AnnabelPrice2,MatthewHotopf2andIreneJHigginson1 Abstract Background:Thereisadearthofdataregardingtheoptimalmethodofdetectingandtreatingdepressionin palliativecare.ThisstudyappliedtheDelphimethodtoevaluateexpertopiniononchoiceofscreeningtool, choiceofantidepressantandchoiceofpsychologicaltherapy.Theaimwastoinformthedevelopmentofbest practicerecommendationsfortheEuropeanPalliativeCareResearchCollaborativeclinicalpracticeguidelineon managingdepressioninpalliativecare. Methods:18membersofaninternational,multi-professionalexpertgroupcompletedastructuredquestionnairein tworounds,ratingtheiragreementwithproposeditemsonascalefrom0-10andannotatingwithadditional comments.Themedianandrangewerecalculatedtogiveastatisticalaverageoftheexperts’ratings. Results:Therewascontentionregardingthebenefitsofscreening,with‘routineinformalasking’(median8.5(0- 10))ratedmorehighlythanformalscreeningtoolssuchastheHospitalAnxietyandDepressionScale(median7.0 (1-10).Mirtazapine(median9(7-10)andcitalopram(median9(5-10)weretheconsideredthebestchoiceof antidepressantandcognitivebehaviouraltherapy(median9.0(3-10)thebestchoiceofpsychologicaltherapy. Conclusions:Therangeofexpertratingswasbroad,indicatingdiscordanceintheviewsofexperts.Direct comparativedatafromrandomisedcontrolledtrialsareneededtostrengthentheevidence-baseandachieve clarityonhowbesttodetectandtreatdepressioninthissetting. Background The European Palliative Care Research Collaborative Themanagementofdepressioninpalliativecareiscom- (EPCRC) recently produced a clinical guideline for the plicated by the physical and psychosocial effects of managementofdepressioninpalliativecaretoimprove advanceddisease.Thesomaticsymptomsofdepression care for this population [8]. The purpose of the guide- (e.g. fatigue, insomnia and poor appetite) mimic those line is