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Br J Cancer. Apr 2001; 84(8): 1011–1015.
PMCID: PMC2363864

Psychiatric morbidity and its recognition by doctors in patients with cancer

Abstract

Psychiatric morbidity in patients with cancer is high and without appropriate treatment unremitting. We assessed the ability of 143 doctors to establish the psychological status of 2297 patients during outpatient consultations in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), designed for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiatric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassification rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong assessment was probably made. These data show that much of the probable psychiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological services are necessary when patients requiring help are identified and ought to be an integral part of cancer care. © 2001 Cancer Research Campaign http://www.bjcancer.com

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Selected References

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  • Baile WF, Kudelka AP, Beale EA, Glober GA, Myers EG, Greisinger AJ, Bast RC, Jr, Goldstein MG, Novack D, Lenzi R. Communication skills training in oncology. Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer. 1999 Sep 1;86(5):887–897. [PubMed]
  • Breitbart W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer. 1995 Jan;3(1):45–60. [PubMed]
  • Carney PA, Eliassen MS, Wolford GL, Owen M, Badger LW, Dietrich AJ. How physician communication influences recognition of depression in primary care. J Fam Pract. 1999 Dec;48(12):958–964. [PubMed]
  • Cella DF, Mahon SM, Donovan MI. Cancer recurrence as a traumatic event. Behav Med. 1990 Spring;16(1):15–22. [PubMed]
  • Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL., Jr The prevalence of psychiatric disorders among cancer patients. JAMA. 1983 Feb 11;249(6):751–757. [PubMed]
  • Fallowfield L. Psychosocial interventions in cancer. BMJ. 1995 Nov 18;311(7016):1316–1317. [PMC free article] [PubMed]
  • Fallowfield LJ, Hall A, Maguire P, Baum M, A'Hern RP. Psychological effects of being offered choice of surgery for breast cancer. BMJ. 1994 Aug 13;309(6952):448–448. [PMC free article] [PubMed]
  • Fallowfield LJ, Hall A, Maguire GP, Baum M. Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ. 1990 Sep 22;301(6752):575–580. [PMC free article] [PubMed]
  • Fallowfield L, Lipkin M, Hall A. Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol. 1998 May;16(5):1961–1968. [PubMed]
  • Ford S, Fallowfield L, Lewis S. Can oncologists detect distress in their out-patients and how satisfied are they with their performance during bad news consultations? Br J Cancer. 1994 Oct;70(4):767–770. [PMC free article] [PubMed]
  • Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med. 1996 Jun;42(11):1511–1519. [PubMed]
  • Gerrity MS, Cole SA, Dietrich AJ, Barrett JE. Improving the recognition and management of depression: is there a role for physician education? J Fam Pract. 1999 Dec;48(12):949–957. [PubMed]
  • Goldberg DP, Jenkins L, Millar T, Faragher EB. The ability of trainee general practitioners to identify psychological distress among their patients. Psychol Med. 1993 Feb;23(1):185–193. [PubMed]
  • Hardman A, Maguire P, Crowther D. The recognition of psychiatric morbidity on a medical oncology ward. J Psychosom Res. 1989;33(2):235–239. [PubMed]
  • Heaven CM, Maguire P. Disclosure of concerns by hospice patients and their identification by nurses. Palliat Med. 1997 Jul;11(4):283–290. [PubMed]
  • Hopwood P, Stephens RJ. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol. 2000 Feb;18(4):893–903. [PubMed]
  • Hopwood P, Howell A, Maguire P. Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer. 1991 Aug;64(2):353–356. [PMC free article] [PubMed]
  • Maguire GP, Lee EG, Bevington DJ, Küchemann CS, Crabtree RJ, Cornell CE. Psychiatric problems in the first year after mastectomy. Br Med J. 1978 Apr 15;1(6118):963–965. [PMC free article] [PubMed]
  • Maguire P. Improving communication with cancer patients. Eur J Cancer. 1999 Dec;35(14):2058–2065. [PubMed]
  • Massie MJ, Holland JC. Depression and the cancer patient. J Clin Psychiatry. 1990 Jul;51 (Suppl):12–19. [PubMed]
  • Meyer TJ, Mark MM. Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomized experiments. Health Psychol. 1995 Mar;14(2):101–108. [PubMed]
  • Newell S, Sanson-Fisher RW, Girgis A, Bonaventura A. How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer. 1998 Oct 15;83(8):1640–1651. [PubMed]
  • Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S. Oncologists' recognition of depression in their patients with cancer. J Clin Oncol. 1998 Apr;16(4):1594–1600. [PubMed]
  • Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, Snashall DC, Timothy AR. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995 Jun;71(6):1263–1269. [PMC free article] [PubMed]
  • Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM. Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996 Mar 16;347(9003):724–728. [PubMed]
  • Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995 Sep 25;155(17):1877–1884. [PubMed]
  • Sellick SM, Crooks DL. Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology. 1999 Jul-Aug;8(4):315–333. [PubMed]
  • Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer. 1999 Aug;80(11):1770–1780. [PMC free article] [PubMed]
  • Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995 May 1;152(9):1423–1433. [PMC free article] [PubMed]
  • Velikova G, Wright EP, Smith AB, Cull A, Gould A, Forman D, Perren T, Stead M, Brown J, Selby PJ. Automated collection of quality-of-life data: a comparison of paper and computer touch-screen questionnaires. J Clin Oncol. 1999 Mar;17(3):998–1007. [PubMed]
  • Whippen DA, Canellos GP. Burnout syndrome in the practice of oncology: results of a random survey of 1,000 oncologists. J Clin Oncol. 1991 Oct;9(10):1916–1920. [PubMed]

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