IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)

Alex Mitchell alex.mitchell@leicspart.nhs.ukNHS 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)

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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

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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