Article Figures & Data
Tables
Identification of depression in palliative patients How do you recognize depression in a palliative patient? Which specific complaints trigger you to think of depression? What role do informal caregivers play in the assessment of depression? How often do you recognize depression in a palliative patient? Do you recognize or diagnose depression more easily in your palliative care patients after gaining more knowledge and experience in palliative care due to education and training? How would you describe the process of diagnosing depression in a palliative patient? Do you use guidelines or standards in diagnosing depression in a palliative patient? What difficulties do you experience in diagnosing depression in a palliative patient? Have you had the experience where you missed a diagnosis of depression in a palliative patient or have recognized it (too) late? Management of depressive symptoms in palliative patients What is your general management for depression in palliative care patients? What is your specific management for depression in palliative care patients? Did your approach of depression in palliative care patients change after gaining more knowledge and experience in palliative care? How do you perceive your role as a doctor in managing depression in palliative care patients? How are partners, spouses, and other close relatives of a palliative care patient involved in managing depression in palliative care patients? Needs and solutions What is needed in primary care to improve the identification and management of depressive complaints in the palliative phase? Characteristic No. (%) Sex Male 13 (59) Female 9 (41) Employment status Full timea 12 (55) Part time 10 (45) Practice setting Rural 6 (29) Suburban 9 (41) Urban 6 (29) Experience and expertise Mean (Range) Experience as a family physician, y 18 (3–33) Patients in their practice, No. 4,575 (1,850–7,300) Estimated palliative patients per year, No. 11.5 (3–20) VAS scoreb expertise in palliative care, cm 6.7 (3.4–8.4) VAS scoreb expertise in mental health care, cm 6.4 (2.9–7.9)
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The Article in Brief
How Family Physicians Address Diagnosis and Management of Depression in Palliative Care Patients
Franca Warmenhoven , and colleagues
Background Depression is common in palliative care patients. In clinical practice there is concern about both under- and overdiagnosis and treatment of depression. This study explores the opinions of 22 family physicians in The Netherlands about the recognition, diagnosis, and management of depression in palliative care patients.
What This Study Found Family physicians in The Netherlands perceive the diagnosis and management of depression in palliative care patients as challenging but generally feel competent to address the issue. Focus group discussions found that physicians do not strictly apply criteria of depressive disorder when evaluating patients but rather rely on their clinical judgment and strongly considered patients' context and background factors. The participants acknowledged difficulty in discerning depression from normal sadness and identified a lack of knowledge, time, and additional support sources as challenges.
Implications
- The authors recommend improving family physician education by building on the elements the study participants identified as key in diagnosing depression and distinguishing it from normal sadness: strengthening continuity of care and relationship-building with patients and their families through the course of palliative care, and explicitly addressing sadness as part of the normal process of coming to terms with the prospect of end of life.
- Guidelines, criteria, and other tools will provide valuable support only when applied in the context of such a patient-centered approach, according to the authors.
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