Background Anxiety and depression are under-diagnosed and under-treated in palliative care with prevalence thought to be 20%–49%. The Palliative Adult Network Guidelines state that psychological assessment is imperative to guide management. The Outcome Assessment and Complexity Collaborative (OACC) is seeking to implement outcome measures into routine palliative care that may improve practice.
Aim To review whether psychological symptoms including mood state and anxiety were being assessed and reviewed in patients admitted to St John’s Hospice, Moggerhanger, UK.
Method Data were collected from 28 patients admitted to St John’s Hospice during August 2015. Psychological assessment recorded in their medical notes were systematically reviewed using a checklist devised from OACC.
The medical clerking was then changed in line with OACC so the psychological assessment included two questions taken from Integrated Palliative care Outcome Scale:
Over the past 3 days, have you been feeling anxious or worried about your illness or treatment?
Have you been feeling depressed?
A separate assessment of Information and Insight was also introduced.
All case notes were re-audited in November 2015.
Results 80% of patients had a psychological assessment completed by a doctor but only 35% mentioned mood or anxiety. Most common non-mood or anxiety related comments related to physical symptoms, prognosis or insight.
At re-audit, 100% of patients had a medical psychological assessment and there was a significant decrease in recording of non-mood symptoms.
Conclusions Without clear prompts, doctors often made poor assessments focusing on non-mood symptoms like insight or prognosis. Implementing OACC caused significant improvements in psychological assessment of patients by doctors. The change required minimal training. OACC can be a powerful and measurable tool for improving patient assessment.
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