93 Screening for depression and anxiety in palliative care inpatients: a quality improvement project

<h3></h3> Depression and anxiety is prevalent in the palliative care population, with recent studies estimating that as many as a quarter of patients meet criteria for at least one anxiety or depressive disorder. Despite this, depression and anxiety in this population is often underdiagnosed and untreated, with evidence showing that this may lead to worse morbidity and mortality outcomes, including increased severity of physical symptoms. 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. A baseline 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, depression, or both, on initial clerking, and 66.7% of the cohort 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. The HADS was administered to 83.3% of patients meeting the inclusion criteria, with a 75% success rate for developing multidisciplinary action plans. 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, but raises further questions about the best choice of tool given our multi-lingual and multicultural population.