Table 2 Experts' ratings: Method of detection

Routine informal asking*

Round 2: Median 8.5 (0-10); n = 10

-It is entirely appropriate to ask patients about their mood as part of a comprehensive symptom assessment

Two-items (low mood & loss of interest)

Round 1: Median 8.0 (4-10); n = 13

Round 2: Median 7.0 (2-9); n = 13

-Too rigid, it seems the shortest summary of a long screening questionnaire

-There is evidence to support this

-We are talking about screening, not assessment: if patient presents with a symptom then full assessment, but if screening otherwise mentally well population then this is a useful tool

Hospital Anxiety and Depression Scale

Round 1: Median 7.0 (1-10); n = 13

Round 2: Median 7.0 (1-10); n = 13

-Long to complete for palliative care patients

-Have used it in palliative care patients very successfully

-I don't find this difficult to use in palliative care in hospice or hospital setting, even for pretty weary patients

-Is just a screener for emotional distress, not useful in diagnosing depression

-Very useful, very acceptable, very under-rated. For some reason the palliative care community have got it in for the HADS, but I don't think there is any evidence that any other measure is better, and quite a few are a lot worse

-Less clear distinction between depression and anxiety

Single-item "Are you depressed?"

Round 1: Median 5.0 (0-10); n = 13

Round 2: Median 7.0 (0-10); n = 12

-I know the limitations, but in my experience helpful in daily practice

-Not really specific

-Too direct and one closed question is not enough screening

-Chochinov's first paper was based on a false premise. It does sort of work, though, but pretty non-discriminating

As part of generic symptom assessment (e.g. POS, ESAS)

Round 1: Median 7.0 (2-10); n = 13

Round 2: Median 6.5 (1-10); n = 14

-Good just as first wide screening, utilizes open questions within a conversation about many other symptoms, hence less fear ... less defence in answer, nevertheless not enough for a full screening

-These aren't at all bad

-Screening by definition has to be simple and quick. Don't confuse screening with severity assessment, there needs to be a 2 stage process: 1) screen; 2) if patient screens positive then use a tool to assess severity

Brief Edinburgh Depression Scale (BEDS)

Round 1: Median 8.0 (2-10); n = 9

Round 2: Median 5.0 (1-9); n = 12

-Easy to use

-The simplified version; but the 6 sentences are too crude for our patients

Beck's Depression Inventory*

Round 2: Median 5.0 (0-8); n = 12

-Largely about thinking style and content and thus relatively un-skewed by physical problems. A better scale for measuring progress than HADS

-Better use only for assessment

-After screening, if practitioner is experienced and confident to use, but this is really for specialist psychiatric services

Prime-MD PHQ-9

Round 1: Median 5.0 (0-10); n = 11

Round 2: Median 3.0 (0-9); n = 11

-Too complex

-Too long

-For assessment

-It's a diagnostic tool, but it's pretty acceptable and not very difficult to use

- It's a severity tool, it is easy to use, primary care practitioners will be familiar with this

Distress Thermometer (DT)

Round 1: Median 6.0 (0-8); n = 9

Round 2: Median 2.0 (0-10); n = 13

-Distress and depression are different

-Useful screen for generalists to decide whether to refer for specialist help

-Useful to integrate depression in routine screening of other symptoms, mixed with distress, hence perceived by patients not as psychiatric inquiry.