OP-11 Screening for depression and anxiety in palliative care inpatients: a quality improvement project

<h3>Introduction</h3> Depression and anxiety is prevalent in the palliative care population, with recent studies estimating that as many as 25% of patients meet criteria for an anxiety or depressive disorder. However, depression and anxiety in this population is often underdiagnosed and untreated, with evidence showing that this may worsen morbidity and mortality outcomes. <h3>Aims</h3> The aim of this project was to improve the detection of depression and anxiety in palliative care patients in Hospice inpatient unit (IPU), and facilitate the provision of targeted multidisciplinary support to patients suffering from psychological distress. <h3>Methods</h3> A retrospective audit of the IPU admission clerking and initial Integrated Palliative care Outcome Scale (IPOS) for patients admitted to the ward was conducted over a one-month period. This identified 54.5% of the inpatient cohort who expressed symptoms of anxiety and/or depression on initial clerking, and 66.7% of the cohort who scored highly in one or more of three key categories on initial IPOS questionnaire: a) Anxiety about illness, b) Feeling at peace, and c) Feeling depressed. Subsequently, the Hospital Anxiety and Depression Scale (HADS) was trialled as a formal screening tool to identify patients who would benefit from a holistic and personalised action plan for their mood, factoring in patients’ psychological, spiritual and social needs. <h3>Results</h3> 75% patients who scored ’abnormal’ on the HADS had their mood symptoms recognised in the weekly MDT meeting, with a 75% success rate of developing holistic action plans. <h3>Conclusion</h3> The results of the first cycle of this project demonstrate that there is scope for the implementation of a formal screening tool to identify depression and anxiety in the inpatient palliative care population in order to ameliorate holistic support for these symptoms. <h3>Impact</h3> Overall, the project raises further questions about the best choice of tool given our multi-lingual and multicultural population. <h3>References</h3> Austin P, Wiley S, McEvoy P, Archer L. Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. <i>Palliative and Supportive Care</i> 2011;<b>9</b>(4);393–400. doi:10.1017/S1478951511000411 Götze H, Brähler E, Gansera L, Polze N, Köhler N. Psychological distress and quality of life of palliative care patients and their caring relatives during home care. <i>Support Care Cancer</i> 2014;<b>22:</b>2775–82. Holtom N, Barraclough J. Is the hospital anxiety and depression scale (HADS) useful in assessing depression in palliative care? <i>Palliative Medicine</i> 2000;<b>14</b>(3):219–220. Hotopf M, Chidgey J, Addington-Hall J, Ly K. Depression in advanced disease: a systematic review part 1. Prevalence and case finding. <i>Journal of Palliative Medicine</i> 2002;81–97. Irwin SA, Rao S, Bower K, Palica J, Rao SS, Maglione JE, . . . Ferris FD. Psychiatric issues in palliative care: recognition of depression in patients enrolled in hospice care. <i>Journal of Palliative Medicine</i> 2008;<b>11</b>(2):158–163. Lawrie I, Lloyd-Williams M, Taylor F. How do palliative medicine physicians assess and manage depression. <i>Palliative Medicine</i> 2004;<b>18</b>(3):234–8. Le Fevre P, Devereux J, Smith S, Lawrie SM, Cornbleet M. Screening for psychiatric illness in the palliative care inpatient setting: a comparison between the hospital anxiety and depression scale and the general health questionnaire-12. <i>Palliative Medicine</i> 1999;<b>13</b>(5):399–407. Lloyd-Williams M, Shiels C, Dowrick C. The development of the brief edinburgh depression scale (BEDS) to screen for depression in patients with advanced cancer. <i>Journal of Affective Disorders</i> 2007;<b>99</b>(1–3):259–64. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the world health surveys. <i>Lancet</i> 2007;<b>370</b>(9590):851–8. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. <i>Psychological Medicine</i> 2010;<b>40</b>(11):1797–810. Rodríguez-Mayoral O, Rodríguez-Ortíz B, Ascencio-Huertas L, Peña-Nieves A, Verástegui E, Allende-Pérez S, Lloyd-Williams M. Validation of the brief edinburgh depression scale (BEDS) in a Mexican population with advanced cancer in a palliative care service. <i>Palliative and Supportive Care</i> 2019;<b>17</b>(4):436–440. Spiegel D, Bloom JR. Group therapy and hypnosis reduce metastatic breast carcinoma pain. <i>Journal of Psychosomatic Medicine</i> 1983;<b>45</b>(4):333–9. WHO. (2024). WHO Definition of Palliative Care. Retrieved September 9th, 2024, from World Health Organization: https://www.who.int/health-topics/palliative-care Wilson K, Chochinov H, Skirko M, Allard P, Chary S, Gagnon P, . . . Clinch J. Depression and anxiety disorders in palliative cancer care. <i>Journal of Pain and Symptom Management</i> 2007;<b>33</b>(2):118–129.