Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates.
Oncologists' perception of depressive symptoms in patients with advanced cancer: accuracy and relational correlates.
复制标题
DOI：
10.1186/s40359-015-0063-6
复制
发表时间：
2015
期刊：
影响因子：
3.6
通讯作者：
Sultan S
中科院分区：
文献类型：
--
作者：
Gouveia L;Lelorain S;Brédart A;Dolbeault S;Bonnaud-Antignac A;Cousson-Gélie F;Sultan S
医疗保健提供者经常不准确地感知癌症患者的抑郁。这项研究的主要目的是检查肿瘤学家和患者对特定抑郁症状的一致性，并确定准确检测的潜在预测因素。201名成年晚期癌症患者(从四个法国肿瘤学单位招募)和他们的肿瘤学家(N = ，28人)报告了抑郁症状，其中8个核心症状来自BDI-SF。采用不同的一致性指数以及Logistic回归分析对数据进行分析。对于个别症状，敏感度和特异度的中位数分别为33%和71%。自杀意念、自我厌恶、内疚和失败感的敏感度最低，而负面身体形象、悲观和悲伤的特异度最低。与基本比率无关的指数显示总体一致性较差(DOR中位数 = 为1.80；ICC值中值为 = .30)。对于失败感、自我厌恶和负罪感等更难识别的症状，情况尤其如此。检测抑郁的敏感性为52%，特异性为69%。发现窘迫的灵敏度为%，特异度为65%。Logistic回归分析表明，同情关怀、关系质量和肿瘤学家的自我效能感是患者-医生一致性的预测因子，主要是在较难识别的症状上。这些结果表明，肿瘤学家很难准确地检测出抑郁症状。考虑到肿瘤学家是心理社会服务的重要联络人，低水平的准确性是有问题的。这突显了使用有效的筛查测试的重要性。专注于心理教育和关系技能的简单培训也可以更好地检测出难以察觉的关键抑郁症状。
Health care providers often inaccurately perceive depression in cancer patients. The principal aim of this study was to examine oncologist-patient agreement on specific depressive symptoms, and to identify potential predictors of accurate detection. 201 adult advanced cancer patients (recruited across four French oncology units) and their oncologists (N = 28) reported depressive symptoms with eight core symptoms from the BDI-SF. Various indices of agreement, as well as logistic regression analyses were employed to analyse data. For individual symptoms, medians for sensitivity and specificity were 33% and 71%, respectively. Sensitivity was lowest for suicidal ideation, self-dislike, guilt, and sense of failure, while specificity was lowest for negative body image, pessimism, and sadness. Indices independent of base rate indicated poor general agreement (median DOR = 1.80; median ICC = .30). This was especially true for symptoms that are more difficult to recognise such as sense of failure, self-dislike and guilt. Depression was detected with a sensitivity of 52% and a specificity of 69%. Distress was detected with a sensitivity of 64% and a specificity of 65%. Logistic regressions identified compassionate care, quality of relationship, and oncologist self-efficacy as predictors of patient-physician agreement, mainly on the less recognisable symptoms. The results suggest that oncologists have difficulty accurately detecting depressive symptoms. Low levels of accuracy are problematic, considering that oncologists act as an important liaison to psychosocial services. This underlines the importance of using validated screening tests. Simple training focused on psychoeducation and relational skills would also allow for better detection of key depressive symptoms that are difficult to perceive.