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Open Access Highly Accessed Research article

Expert opinion on detecting and treating depression in palliative care: A Delphi study

Lauren Rayner12*, Annabel Price2, Matthew Hotopf2 and Irene J Higginson1

Author Affiliations

1 Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, UK

2 Department of Psychological Medicine, The Institute of Psychiatry, King's College London, UK

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BMC Palliative Care 2011, 10:10  doi:10.1186/1472-684X-10-10

Published: 27 May 2011

Abstract

Background

There is a dearth of data regarding the optimal method of detecting and treating depression in palliative care. This study applied the Delphi method to evaluate expert opinion on choice of screening tool, choice of antidepressant and choice of psychological therapy. The aim was to inform the development of best practice recommendations for the European Palliative Care Research Collaborative clinical practice guideline on managing depression in palliative care.

Methods

18 members of an international, multi-professional expert group completed a structured questionnaire in two rounds, rating their agreement with proposed items on a scale from 0-10 and annotating with additional comments. The median and range were calculated to give a statistical average of the experts' ratings.

Results

There was contention regarding the benefits of screening, with 'routine informal asking' (median 8.5 (0-10)) rated more highly than formal screening tools such as the Hospital Anxiety and Depression Scale (median 7.0 (1-10). Mirtazapine (median 9 (7-10) and citalopram (median 9 (5-10) were the considered the best choice of antidepressant and cognitive behavioural therapy (median 9.0 (3-10) the best choice of psychological therapy.

Conclusions

The range of expert ratings was broad, indicating discordance in the views of experts. Direct comparative data from randomised controlled trials are needed to strengthen the evidence-base and achieve clarity on how best to detect and treat depression in this setting.