Background Depression is common in palliative care, whether it is major depressive disorder or depressive symptoms. Depression compounds the physical consequences of advanced disease. It is associated with disability, pain and fatigue, with evidence suggesting those with depression have a poorer prognosis and higher mortality. Therefore, having a high screening vigilance for symptoms that may cluster together through systematic holistic assessment (IPOS), and clear pathways guiding interventions, is key. We aim to explore the role of the holistic assessment tool in driving interventions for depression.
Methods Retrospective case-note review of patients known to hospice services, across integrated community and inpatient teams who had holistic assessment completed.
Results 100 case notes were electronically reviewed, with IPOS depression only recorded in 62% of cases. 52% of IPOS scored ‘0’, 35% scored ‘1–2’ and 13% scored ‘3–4’ for the depression screening question. Once the triggering question on IPOS was 3 or above only 33% had their IPOS repeated, 63% had a mental health risk assessment, but nobody had additional screening with a validated depression tool (e.g. HADS). Interventions ranged from low level ‘Wellbeing’ type to the more psychologically focused ‘talking therapies’, however there was no clear pathway for ensuring all patients should have access to all the services the hospice offers whether that be drug or non-drug based.
Conclusions This piece of work highlights the opportunity with IPOS to screen for depression but requires a more systematic approach to further guide diagnosis and interventions. Given the challenges from the initial holistic assessment (IPOS), with only 62% having the depression question completed, further data capture to aid detection is crucial. The organisation has moved to mandated electronic field completion of IPOS, enabling the holistic assessment of needs to guide the most appropriate interventions.
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