Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-25T02:31:47.861Z Has data issue: false hasContentIssue false
  • English
  • Français

Accuracy of oncologist assessments of psychiatric problems in cancer inpatients

Published online by Cambridge University Press:  03 May 2017

Daisuke Yasugi ,
Hidetaka Tamune ,
Jitsuki Sawamura  and
Katsuji Nishimura
Daisuke Yasugi*
Affiliation:
Department of Psychiatry, Tokyo Metropolitan Health and Medical Treatment Corporation Toshima Hospital, Tokyo, Japan Department of Neuropsychiatry, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Hidetaka Tamune
Affiliation:
Department of Neuropsychiatry, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Jitsuki Sawamura
Affiliation:
Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
Katsuji Nishimura
Affiliation:
Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
*
Address correspondence and reprint requests to: Daisuke Yasugi, Department of Psychiatry, Tokyo Metropolitan Health and Medical Treatment Corporation Toshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo 173-0015Japan. E-Mail: yasugi-psy@umin.ac.jp.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Our objective was to examine the accuracy of non-psychiatrist assessments of psychiatric problems in cancer patients.

Method:

We conducted a retrospective chart review of cancer patients who were admitted and referred to the consultation–liaison (C–L) team between January of 2011 and December of 2012. The agreement between non-psychiatrist assessments and final diagnoses by attending C–L psychiatrists was estimated for every category of referral assessment using codes from the International Classification of Mental and Behavioral Disorders (10th revision). The data were obtained from the consultation records of 240 cancer inpatients who were referred to the C–L service at a tertiary care center in Tokyo.

Results:

The agreement ratio between referring oncologists and psychiatrists differed according to the evaluation categories. The degrees of agreement for the categories of “delirious,” “depressive,” “dyssomnia,” “anxious,” “demented,” “psychotic,” and “other” were 0.87, 0.43, 0.51, 0.50, 0.27, 0.55, and 0.57, respectively. The agreement for all patients was 0.65. Significant differences were observed among seven categories (chi-squared value = 42.454 at p < 0.001 and df = 6). The analysis of means for proportions showed that the degree of agreement for the “delirious” category was significantly higher and that that for the “depressive” category was lower than that for all patients, while for the “demented” category it was close to the lower decision limit but barely significant. One half of the 20 cases who were referred as depressive were diagnosed with delirium, with one quarter of those having continuously impaired consciousness. Some 7 of the 11 cases who were referred as demented were diagnosed as having delirium.

Significance of Results:

The accuracy of non-psychiatrist assessments for psychiatric problems in cancer patients differs by presumed diagnosis. Oncologists should consider unrecognized delirium in cancer inpatients who appear depressed or demented.

Keywords

Diagnostic errorCancer carePsychiatric diagnosisDeliriumInpatients
Type
Original Articles
Information
Palliative & Supportive Care , Volume 16 , Special Issue 1: Special Instruments – Assessment and Measure Issues in Palliative Care , February 2018 , pp. 41 - 49
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Boland, R.J., Diaz, S., Lamdan, R.M., et al. (1996). Overdiagnosis of depression in the general hospital. General Hospital Psychiatry, 18(1), 28–35.Google Scholar
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13(3), 128–137.CrossRefGoogle ScholarPubMed
Breitbart, W., Gibson, C. & Tremblay, A. (2002). The delirium experience: Delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics, 43(3), 183–194.Google Scholar
Bruera, E., Kuehn, N., Miller, M.J., et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7(2), 6–9.CrossRefGoogle ScholarPubMed
Bruera, E., Bush, S.H., Willey, J., et al. (2009). Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer, 115(9), 2004–2012. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752862/.CrossRefGoogle ScholarPubMed
Carey, M., Jones, K., Meadows, G., et al. (2014). Accuracy of general practitioner unassisted detection of depression. The Australian and New Zealand journal of Psychiatry, 48(6), 571–578. Epub ahead of print Jan 10. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230951/.CrossRefGoogle ScholarPubMed
Cepoiu, M., McCusker, J., Cole, M.G., et al. (2008). Recognition of depression by non-psychiatric physicians: A systematic literature review and meta-analysis. Journal of General Internal Medicine, 23(1), 25–36. Epub ahead of print Oct 26, 2007. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2173927/.Google Scholar
Chiu, N.M., Chen, C.L. & Cheng, A.T.A. (2009). Psychiatric consultation for post-liver-transplantation patients: Regular article. Psychiatry and Clinical Neurosciences, 63(4), 471–477. Available from http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2009.01987.x/full.CrossRefGoogle Scholar
Derogatis, L.R., Morrow, G.R., Fetting, J., et al. (1983). The prevalence of psychiatric disorders among cancer patients. The Journal of the American Medical Association, 249(6), 751–757.Google Scholar
Fang, C.K., Chen, H.W., Liu, S.I., et al. (2008). Prevalence, detection and treatment of delirium in terminal cancer inpatients: A prospective survey. Japanese Journal of Clinical Oncology, 38(1), 56–63. Epub ahead of print Jan 31. Available from https://academic.oup.com/jjco/article-lookup/doi/10.1093/jjco/hym155.CrossRefGoogle ScholarPubMed
Farrell, K.R. & Ganzini, L. (1995). Misdiagnosing delirium as depression in medically ill elderly patients. Archives of Internal Medicine, 155(22), 2459–2464.Google Scholar
Gagnon, P., Allard, P., Mâsse, B., et al. (2000). Delirium in terminal cancer. Journal of Pain and Symptom Management, 19(6), 412–426.CrossRefGoogle ScholarPubMed
Hey, J., Hosker, C., Ward, J., et al. (2015). Delirium in palliative care: Detection, documentation and management in three settings. Palliative & Supportive Care, 13(6), 1541–1545. Epub ahead of print Oct 21, 2013.CrossRefGoogle ScholarPubMed
Hui, D. (2015). Prognostication of survival in patients with advanced cancer: Predicting the unpredictable? Cancer Control: Journal of the Moffitt Cancer Center, 22(4), 489–497. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769860/.CrossRefGoogle ScholarPubMed
Kim, K.W., Lee, D.Y., Jhoo, J.H., et al. (2005). Diagnostic accuracy of Mini-Mental Status Examination and Revised Hasegawa Dementia Scale for Alzheimer's disease. Dementia and Geriatric Cognitive Disorders. 19(5–6), 324–330. Epub ahead of print Mar 22.CrossRefGoogle ScholarPubMed
Lawlor, P.G. & Bush, S.H. (2014). Delirium diagnosis, screening and management. Current Opinion in Supportive and Palliative Care, 8(3), 286–295. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162328/.CrossRefGoogle ScholarPubMed
Lawlor, P.G., Gagnon, B., Mancini, I.L., et al. (2000 a). Occurrence, causes, and outcome of delirium in patients with advanced cancer: A prospective study. Archives of Internal Medicine, 160(6), 786–794.Google Scholar
Lawlor, P.G., Nekolaichuk, C., Gagnon, B., et al. (2000 b). Clinical utility, factor analysis, and further validation of the Memorial Delirium Assessment Scale in patients with advanced cancer: Assessing delirium in advanced cancer. Cancer, 88(12), 2859–2867.3.0.CO;2-T>CrossRefGoogle ScholarPubMed
Leonard, M., Raju, B., Conroy, M., et al. (2008). Reversibility of delirium in terminally ill patients and predictors of mortality. Palliative Medicine, 22(7), 848–854. Epub ahead of print Aug 28.Google Scholar
Leonard, M.M., Agar, M., Spiller, J.A., et al. (2014). Delirium diagnostic and classification challenges in palliative care: Subsyndromal delirium, comorbid delirium–dementia, and psychomotor subtypes. Journal of Pain and Symptom Management, 48(2), 199–214. Epub ahead of print May 28.Google Scholar
Maltoni, M., Scarpi, E., Pittureri, C., et al. (2012). Prospective comparison of prognostic scores in palliative care cancer populations. The Oncologist, 17(3), 446–454. Epub ahead of print Feb 29. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316931/.Google Scholar
Meagher, D., O'Regan, N., Ryan, D., et al. (2014). Frequency of delirium and subsyndromal delirium in an adult acute hospital population. The British Journal of Psychiatry, 205(6), 478–485. Epub ahead of print Oct 30. Available from http://bjp.rcpsych.org/content/205/6/478.long.Google Scholar
Meagher, J., Leonard, M., Donoghue, L., et al. (2015). Months backward test: A review of its use in clinical studies. World Journal of Psychiatry, 5(3), 305–314. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582306/.Google Scholar
Meijer, A., Roseman, M., Milette, K., et al. (2011). Depression screening and patient outcomes in cancer: A systematic review. PloS One, 6(11), e27181. Epub ahead of print Nov 14. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215716/.Google Scholar
Mitchell, A.J., Chan, M., Bhatti, H., et al. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. The Lancet. Oncology, 12(2), 160–174. Epub ahead of print Jan 19.Google Scholar
Morita, T., Akechi, T., Ikenaga, M., et al. (2007). Terminal delirium: Recommendations from bereaved families' experiences. Journal of Pain and Symptom Management, 34(6), 579–589. Epub ahead of print Jul 26.Google Scholar
Newell, S., Sanson-Fisher, R.W., Girgis, A., et al. (1998). How well do medical oncologists' perceptions reflect their patients' reported physical and psychosocial problems? Data from a survey of five oncologists. Cancer, 83(8), 1640–1651.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Nicholas, L.M. & Lindsey, B.A. (1995). Delirium presenting with symptoms of depression. Psychosomatics, 36(5), 471–479.Google Scholar
O'Regan, N.A., Ryan, D.J., Boland, E., et al. (2014). Attention! A good bedside test for delirium? Journal of Neurology, Neurosurgery, and Psychiatry, 85(10), 1122–1131. Epub ahead of print Feb 25. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173985/.Google Scholar
Pelletier, G., Verhoef, M.J., Khatri, N., et al. (2003). Quality of life in brain tumor patients: The relative contributions of depression, fatigue, emotional distress, and existential issues. Journal of Neuro-Oncology, 57(1), 41–49.Google Scholar
Portenoy, R.K., Thaler, H.T., Kornblith, A.B., et al. (1994). Symptom prevalence, characteristics and distress in a cancer population. Quality of Life Research, 3(3), 183–189.Google Scholar
Rayner, L., Price, A., Evans, A., et al. (2011 a). Antidepressants for the treatment of depression in palliative care: Systematic review and meta-analysis. Palliative Medicine, 25(1), 36–51. Epub ahead of print Oct 8, 2010. Available from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0031520/.Google Scholar
Rayner, L., Price, A., Hotopf, M., et al. (2011 b). Expert opinion on detecting and treating depression in palliative care: A Delphi study. BMC Palliative Care, 10, 10. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125275/.Google Scholar
Rhondali, W., Perceau, E., Saltel, P., et al. (2012). Depression assessment by oncologists and palliative care physicians. Palliative & Supportive Care, 10(4), 255–263. Epub ahead of print May 15.CrossRefGoogle ScholarPubMed
Rhondali, W., Freyer, G., Adam, V., et al. (2015). Agreement for depression diagnosis between DSM–IV–TR criteria, three validated scales, oncologist assessment, and psychiatric clinical interview in elderly patients with advanced ovarian cancer. Clinical Interventions in Aging, 10, 1155–1162. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506027/.Google Scholar
Sharpe, M., Walker, J., Holm Hansen, C., et al. (2014). Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology–2): A multicentre randomised controlled effectiveness trial. Lancet, 384(9948), 1099–1108. Epub ahead of print Aug 27.CrossRefGoogle ScholarPubMed
van den Dungen, P., van Marwijk, H.W.M., van der Horst, H.E., et al. (2012). The accuracy of family physicians' dementia diagnoses at different stages of dementia: A systematic review. International journal of Geriatric Psychiatry, 27(4), 342–354. Epub ahead of print May 30, 2011. Available from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047991/.Google Scholar
Watanabe, S.M., Nekolaichuk, C.L. & Beaumont, C. (2012). The Edmonton Symptom Assessment System, a proposed tool for distress screening in cancer patients: Development and refinement. Psycho-Oncology, 21(9), 977–985. Epub ahead of print Jun 13.Google Scholar
World Health Organization (1992). The International Classification of Mental and Behavioral Disorders, 10th revision (ICD–10). Geneva: World Health Organization. Available from http://www.who.int/classifications/icd/en/.Google Scholar
Yamada, K., Hosoda, M., Nakashima, S., et al. (2012). Psychiatric diagnosis in the elderly referred to a consultation–liaison psychiatry service in a general geriatric hospital in Japan. Geriatrics & Gerontology International, 12(2), 304–309. Epub ahead of print Nov 28, 2011.Google Scholar