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Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates.

Gouveia L, Lelorain S, Brédart A, Dolbeault S, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S - BMC Psychol (2015)

Bottom Line: Various indices of agreement, as well as logistic regression analyses were employed to analyse data.Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services.This underlines the importance of using validated screening tests.

View Article: PubMed Central - PubMed

Affiliation: Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada.

ABSTRACT

Background: Health care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection.

Methods: 201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data.

Results: For individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms.

Conclusions: The results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.

No MeSH data available.


Related in: MedlinePlus

Percent frequency of patient-oncologist agreement on distress. Agreement/disagreement was determined according to the DT cutoff score (4). The figure only features the oncologists who saw ten patients (n = 12). Values are displayed with 95% confidence intervals.
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Fig2: Percent frequency of patient-oncologist agreement on distress. Agreement/disagreement was determined according to the DT cutoff score (4). The figure only features the oncologists who saw ten patients (n = 12). Values are displayed with 95% confidence intervals.

Mentions: The present study has several limitations. First, it must be noted that the situation in which oncologists were placed is unnatural and may therefore limit the applicability of the results. Perhaps physicians tended to overestimate symptoms simply because the perspective-taking task attracted their attention to them. Secondly, the results may be affected by a selection bias, as less than 50% of the contacted physicians participated in the study. Perhaps interest in empathy is related to accuracy on patient distress. Thirdly, the limited sample size combined with the high number of variables likely led to underpowered analyses. The findings should therefore be considered as exploratory in nature. Fourthly, many of the measures have limited reliability due to either low internal consistency (JSPE) or a one-item structure (depressive symptoms, self-efficacy, quality of relationship). Fifthly, some of the predictor variables are not independent and thus may violate the logistic regression assumptions. Consequently, results involving the perspective-taking and compassionate care scores from the JSPE should be considered with caution. Sixthly, it may be argued that between-physician differences explain part of the results. To explore this avenue, we compared agreement rates between physicians and found no significant differences (Figures 1 and 2). Multilevel analyses with larger samples would be recommended in future studies.Figure 1


Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates.

Gouveia L, Lelorain S, Brédart A, Dolbeault S, Bonnaud-Antignac A, Cousson-Gélie F, Sultan S - BMC Psychol (2015)

Percent frequency of patient-oncologist agreement on distress. Agreement/disagreement was determined according to the DT cutoff score (4). The figure only features the oncologists who saw ten patients (n = 12). Values are displayed with 95% confidence intervals.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359512&req=5

Fig2: Percent frequency of patient-oncologist agreement on distress. Agreement/disagreement was determined according to the DT cutoff score (4). The figure only features the oncologists who saw ten patients (n = 12). Values are displayed with 95% confidence intervals.
Mentions: The present study has several limitations. First, it must be noted that the situation in which oncologists were placed is unnatural and may therefore limit the applicability of the results. Perhaps physicians tended to overestimate symptoms simply because the perspective-taking task attracted their attention to them. Secondly, the results may be affected by a selection bias, as less than 50% of the contacted physicians participated in the study. Perhaps interest in empathy is related to accuracy on patient distress. Thirdly, the limited sample size combined with the high number of variables likely led to underpowered analyses. The findings should therefore be considered as exploratory in nature. Fourthly, many of the measures have limited reliability due to either low internal consistency (JSPE) or a one-item structure (depressive symptoms, self-efficacy, quality of relationship). Fifthly, some of the predictor variables are not independent and thus may violate the logistic regression assumptions. Consequently, results involving the perspective-taking and compassionate care scores from the JSPE should be considered with caution. Sixthly, it may be argued that between-physician differences explain part of the results. To explore this avenue, we compared agreement rates between physicians and found no significant differences (Figures 1 and 2). Multilevel analyses with larger samples would be recommended in future studies.Figure 1

Bottom Line: Various indices of agreement, as well as logistic regression analyses were employed to analyse data.Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services.This underlines the importance of using validated screening tests.

View Article: PubMed Central - PubMed

Affiliation: Centre de recherche, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, H3T 1C5 Montreal, Qc Canada.

ABSTRACT

Background: Health care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection.

Methods: 201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data.

Results: For individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms.

Conclusions: The results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.

No MeSH data available.


Related in: MedlinePlus