The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

被引:11
作者
Brenne, Elisabeth [1 ,2 ]
Loge, Jon H. [1 ,3 ]
Lie, Hanne [3 ]
Hjermstad, Marianne J. [1 ,4 ]
Fayers, Peter M. [1 ,5 ]
Kaasa, Stein [1 ,2 ]
机构
[1] Norwegian Univ Sci & Technol NTNU, Dept Canc Res & Mol Med, European Palliat Care Res Ctr, N-7491 Trondheim, Norway
[2] Univ Trondheim Hosp, St Olavs Hosp, Canc Clin, Trondheim, Norway
[3] Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Oslo, Norway
[4] Oslo Univ Hosp, South Eastern Norway, Reg Ctr Excellence Palliat Care, Oslo, Norway
[5] Univ Aberdeen, Sch Med, Dept Publ Hlth, Aberdeen AB9 2ZD, Scotland
关键词
Palliative care; neoplasms; depression; depressive disorder; symptom assessment; REPORTED OUTCOME MEASURES; PALLIATIVE CARE RESEARCH; HEALTH QUESTIONNAIRE; DIAGNOSTIC-ACCURACY; TOOL; VALIDITY; DISTRESS; ANXIETY; PREVALENCE; VALIDATION;
D O I
10.1177/0269216315620082
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Depressive symptoms are prevalent in patients with advanced cancer, sometimes of a severity that fulfil the criteria for a major depressive episode. Aim: The aim of this study was to investigate how the item on depression in the Edmonton Symptom Assessment System with a 0-10 Numerical Rating Scale performed as a screener for major depressive episode. A possible improved performance by adding the Edmonton Symptom Assessment System-Anxiety item was also examined. Design: An international cross-sectional study including patients with incurable cancer was conducted. The Edmonton Symptom Assessment System score was compared against major depressive episode as assessed by the Patient Health Questionnaire-9. Screening performance was examined by sensitivity, specificity and the kappa coefficient. Setting: Patients with incurable cancer (n=969), median age 63years and from eight nationalities provided report. Median Karnofsky Performance Status was 70. Median survival was 229days (205-255days). Results: Patient Health Questionnaire-9 major depressive episode was present in 133 of 969 patients (13.7%). Edmonton Symptom Assessment System-Depression screening ability for Patient Health Questionnaire-9 major depressive episode was limited. Area under the receiver operating characteristic curve was 0.71 (0.66-0.76). Valid detection or exclusion of Patient Health Questionnaire-9 major depressive episode could not be concluded at any Edmonton Symptom Assessment System-Depression cut-off; by the cut-off Numerical Rating Scale2, sensitivity was 0.69 and specificity was 0.60. By the cut-off Numerical Rating Scale4, sensitivity was 0.51 and specificity was 0.82. Combined mean ratings by Edmonton Symptom Assessment System-Depression and Edmonton Symptom Assessment System-Anxiety revealed similar limited screening ability. Conclusion: The depression and anxiety items of the Edmonton Symptom Assessment System, a frequently used assessment tool in palliative care settings, seem to measure a construct other than major depressive episode as assessed by the Patient Health Questionnaire-9 instrument.
引用
收藏
页码:587 / 598
页数:12
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