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Table 2 Experts' ratings: Method of detection

From: Expert opinion on detecting and treating depression in palliative care: A Delphi study

0 = not useful, 10 = very useful
Experts' comments
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.
  1. *Items suggested by experts in the first round and rated by the group in the second round