Aim
In our previous study (Thalén-Lindström et al. submitted), 176 oncology patients with anxiety or depression symptoms were identified by screening with the HADS, 57% of those declined referral and 44% of the further assessed patients had no need of psychosocial support. Does HADS overestimate patients with anxiety and depression symptoms? The aim was to compare two methods to detect oncology patients with anxiety or depression.
Methods
Randomly selected inpatients and outpatients stratified for sex, age and curative/palliative treatment were included during 2009-2010. The patients completed the HADS within a week before a clinical assessment. An oncology nurse or a social worker, both with undergraduate diploma in cognitive behaviour therapy and oncology work experience performed the assessments. They estimated the patient’s levels of anxiety- and depression symptoms after the session, blinded to the results of HADS. Patients assessed with anxiety or depression were referred to support.
Results
Totally 146 of 171 oncologically treated patients completed the study, evenly distributed over sex, age and curative/palliative treatment. Prostate-, gastrointestinal- and breast cancers were the most common diagnosis. Mean age was 61 (19-87) years. The clinical assessments identified 28 (19%) patients as clinical cases (anxiety and/or depression). Thirteen of them were clinical cases according to the HADS. In total nineteen patients were clinical cases according to the HADS. The overall agreement between the clinical assessment and the HADS was fair to moderate (kappa 0.40 for anxiety and 0.42 for depression). Five of 28 clinical case patients were referred to support, nine had ongoing and five declined support while six patients wanted to wait to receive support.
Conclusion
The clinical assessment sessions identified more patients as clinical cases than the HADS contrary to our expectations. One third of the identified patients had ongoing support and a few others wanted referral.