Objectives: Psychiatric disorders are common and frequently undetected and under treated in the palliative care population. The aims of this pilot study were determine to: (1) the incidence of psychiatric co-morbidity; (2) the patient's current insight; (3) future fears regarding symptom control; and finally (4) the degree of satisfaction with their doctors level of communication, at the time of their diagnosis.
Methods: Over a six-month period, 100 consecutive hospice admissions were assessed by AP, within 72 hours of their arrival. This patient group all had advanced malignant disease. A semi-structured questionnaire was used as a guide (see Table 1) to interview. A full history, cognitive and Mental State Examination (MSE) were performed on each patient.
Results: Sixty-four patients were interviewed, 36 were excluded. Sixteen (25%) had a depressive illness, six (9%) had anxiety, 56 (88%) had full or partial insight into their illness. Only eight (12%) were unaware of the nature or implications of their disease. Of those who responded, 19 (30%) felt dissatisfied with how their doctors communicated their diagnosis. A significant proportion, 30 (47%) felt that eventually their symptoms would become out of control.
Conclusions: This was a pilot study by a psychiatrist at the bedside in the hospice setting. We found that by concentrating on psychological symptoms rather than the biological, a diagnosis of depression was possible even in these complex medical patients. However, recognition of treatable anxiety in this population is a challenge. Even though 30 (47%) felt that their most distressing symptoms would become out of control during the course of their illness, we found an incidence of anxiety of only six (9%). This suggests that our interview underestimates the true level of anxiety in these patients, and highlights the need for a low threshold for diagnosis and possibly an objective screening mechanism. Regarding the ‘breaking of bad news’, 19 (31%) of patients were dissatisfied and unhappy with this experience and there is clearly room for improvement in communicating a diagnosis of malignancy.