Oncologists' recognition of depression in their patients with cancer
Oncologists' recognition of depression in their patients with cancer
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DOI：
10.1200/jco.1998.16.4.1594
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发表时间：
1998-04-01
影响因子：
45.3
通讯作者：
Edgerton, S
中科院分区：
文献类型：
--
作者：
Passik, SD;Dugan, W;Edgerton, S
目的：本研究作为癌症患者抑郁症筛查项目的一部分进行，以确定医生对癌症患者抑郁症状水平的认识程度，并描述影响医生对抑郁症状感知准确性的患者特征。隶属于印第安纳州社区癌症护理公司的25家门诊肿瘤诊所招募并调查了12名肿瘤学家治疗的1,109名受试者。受试者完成Zung抑郁自评量表（Zung Self-Rating Depression Scale，Zung DS），医生被要求使用数字评分量表对患者的抑郁症状、焦虑和疼痛水平进行评分。受试者的性别，年龄，原发性肿瘤类型，药物治疗，主要照顾者，和疾病阶段在diagnosis.Results：医生抑郁症的评级显着相关的患者的水平认可的抑郁症状上的EPDDS。然而，当患者报告很少或没有抑郁症状时，医生和患者之间的协议最常见。虽然医生的评级与患者认可的无显著抑郁症的一致性为79%，但在轻度至中度/重度范围内，它们分别仅为33%和13%。医生评分最受患者认可的频繁和明显的情绪症状，即悲伤，哭泣和易怒。医生评分似乎也受到患者抑郁症状水平（功能状态、疾病分期和肿瘤部位）的医学相关因素的影响。此外，抑郁症被不准确分类的患者报告的疼痛程度显着较高，残疾程度也较高。医生的抑郁症的评级是最高度相关的医生的病人的焦虑和pain.Conclusion的评级：医生的抑郁症状的看法，在他们的病人与病人的评级，但有一个显着的倾向，低估了抑郁症状的患者谁是更抑郁的水平。他们最受哭泣和抑郁情绪等症状的影响，以及有用但不是最可靠的医学因素，这些因素是这一人群中抑郁症的指标。医生对病人痛苦症状的评价似乎是全球性的，它们与焦虑、疼痛和整体功能障碍高度相关。如果指导医生评估和探索更可靠的认知症状，如快感缺乏、内疚、自杀想法和绝望，医生的评估可能会得到改善。筛查工具和使用简短的随访访谈将有助于识别抑郁症患者。(C)1998年，美国临床肿瘤学会。
Purpose: This study was performed as part of a large depression screening project in cancer patients to determine the degree of physician recognition of levels of depressive symptoms in cancer patients and to describe patient characteristics that influence the accuracy of physician perception of depressive symptoms.Methods: Twenty-five ambulatory oncology clinics affiliated with Community Cancer Care, Inc of Indiana enrolled and surveyed 1,109 subjects treated by 12 oncologists. Subjects completed the Zung Self-Rating Depression Scale (ZSDS) and physicians were asked to rate their patients' level of depressive symptoms, anxiety,and pain using numerical rating scales. Subjects' sex, age, primary tumor type, medications, primary caregiver, and disease stage at diagnosis were also recorded.Results: Physician ratings of depression were significantly associated with their patients' levels of endorsement of depressive symptoms on the ZSDS. However, agreement between physicians and patients is most frequently clustered when patients report little or no depressive symptoms. While physician ratings are concordant with patient endorsement of no significant depressive symptomatology 79% of the time, they are only concordant 33% and 13% of the time in the mild-to-moderate/severe ranges, respectively. Physician ratings were most influenced by patient endorsement of frequent and obvious mood symptoms, ie, sadness, crying, and irritability. Physician ratings also appeared to be influenced by medical correlates of patients' level of depressive symptoms (functional status, stage of disease, and site of tumor). Additionally, patients whose depression was inaccurately classified reported significantly higher levels of pain and had higher levels of disability. Physicians' ratings of depression were most highly correlated with physicians' ratings of patients' anxiety and pain.Conclusion: Physicians' perceptions of depressive symptoms in their patients are correlated with patient's ratings, but there is a marked tendency to underestimate the level of depressive symptoms in patients who are more depressed. They are most influenced by symptoms such as crying and depressed mood, and medical factors that are useful, but not the most reliable, indicators of depression in this population. Physicians' ratings of their patients' distress symptoms seem to be global in nature-they are highly correlated with anxiety, pain, and global dysfunction. Physician assessment might be improved if they were instructed to assess and probe for the more reliable cognitive symptoms such as anhedonia, guilt, suicidal thinking, and hopelessness. Screening instruments and the use of brief follow-up interviews would help to identify patients who are depressed. (C) 1998 by American Society of Clinical Oncology.