IPOS2009 – Talk
   IPOS2009 – Talk

  How Accurate are Cancer Professionals’
  How Accurate are Cancer Professionals’
  As...
Background
Background
Methods to Evaluate Depression



 Unassisted Clinician                      Conventional Scales

Untrained Trained       ...
n=226   How=>
Cancer Staff                                                                        Psychiatrists
           Current Metho...
Cancer Staff                                           Psychiatrists
              Ideal Method (n=226)

                 ...
Assessing Clinicians
Assessing Clinicians
Testing Clinicians vs DT
114 ratings from clinical nurse specialists (CNS).


  81 individuals (71%) scored above a cut-of...
Results
                  DT 3v4 (mild, high prevalence)




          DT 4v5 (moderate, medium prevalence)




          ...
1.00




           Post-test Probability
0.90



0.80



0.70



0.60



0.50



0.40


                                 ...
Assessing Clinicians – Meta-Analysis
Assessing Clinicians – Meta-Analysis
Testing Clinicians: A Meta-Analysis
Methods
12 studies reported in 7 publications. Two studies examined
  detection of anx...
Testing Clinicians: A Meta-Analysis
Results
All cancer professionals
SE =39.5% and SP =77.3%.

Oncologists
SE =38.1% and S...
1.00



  0.90       Post-test Probability
                                                      PPV          NPV
  0.80
 ...
Cumulative Recognition
Cumulative Recognition

    => Combinations
    => Combinations
N = 1000
                   Cancer Population
                                 n = 200                                    ...
N = 1000
                      Cancer Population
                                         n = 200                         ...
Poster session 3
(25 June 2009)

Poster category
1

(Communication
skills) Poster Nr.
18
Credits & Acknowledgments

  Elena Baker-Glenn      University of Nottingham
  Paul Symonds           Leicester Royal Infi...
IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)
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IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)

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This is a talk delivered June 2009 to IPOS conference Vienna Austria. The topic is a small meta-analysis of clinicians accuracy in detecting depression in cancer settings.

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IPOS09 - How Accurate are Cancer Professionals’ Assessments of depression and distress (June09)

  1. 1. IPOS2009 – Talk IPOS2009 – Talk How Accurate are Cancer Professionals’ How Accurate are Cancer Professionals’ Assessments of depression and distress: Assessments of depression and distress: A Meta-analysis of Diagnoses by Oncologists & Clinical Nurse Specialists A Meta-analysis of Diagnoses by Oncologists & Clinical Nurse Specialists Alex Mitchell alex.mitchell@leicspart.nhs.uk NHS Consultant Liaison Psychiatrist, Leicester Royal Infirmary UK Paul Symonds Reader in Clinical Oncology, Leicester Royal Infirmary UK Individual Lecture 2-24June 2009: 9.00am (Category Communication Skills) Sess 13 Lect 3
  2. 2. Background Background
  3. 3. Methods to Evaluate Depression Unassisted Clinician Conventional Scales Untrained Trained Short (5-10) Long (10+) Ultra-Short (<5) Acceptability? Acceptability ? Acceptability ? Accuracy? Accuracy? Accuracy? Implementation Implementation Implementation
  4. 4. n=226 How=>
  5. 5. Cancer Staff Psychiatrists Current Method (n=226) Other/Uncertain 9% Other/Uncertain ICD10/DSMIV 2% 0% ICD10/DSMIV 13% Short QQ 3% 1,2 or 3 Sim ple QQ 15% Clinical Skills Use a QQ Alone 15% 55% Clinical Skills Alone 73% 1,2 or 3 Sim ple QQ 15% [handout 6]
  6. 6. Cancer Staff Psychiatrists Ideal Method (n=226) Effective? Long QQ 8% Clinical Skills Clinical Skills Alone Alone Algorithm 20% 17% 26% ICD10/DSMIV 24% ICD10/DSMIV 1,2 or 3 Sim ple 0% 1,2 or 3 Sim ple QQ QQ 24% Short QQ 34% 23% Short QQ 24% [handout 6] Validity=>
  7. 7. Assessing Clinicians Assessing Clinicians
  8. 8. Testing Clinicians vs DT 114 ratings from clinical nurse specialists (CNS). 81 individuals (71%) scored above a cut-off of 3 (mild distress) 64 patients (56%) scored above a cut-off of 4 (moderate distress) 37 (32.4%) individuals scores above 5 (severe distress) [handout 7]
  9. 9. Results DT 3v4 (mild, high prevalence) DT 4v5 (moderate, medium prevalence) DT 5v6 (severe, low prevalence)
  10. 10. 1.00 Post-test Probability 0.90 0.80 0.70 0.60 0.50 0.40 Severe Distress CNS+ 0.30 Severe Distress CNS- Baseline Probability Mild Distress CNS+ 0.20 Mild Distress CNS- Mod Distress CNS+ Mod Distress CNS- 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
  11. 11. Assessing Clinicians – Meta-Analysis Assessing Clinicians – Meta-Analysis
  12. 12. Testing Clinicians: A Meta-Analysis Methods 12 studies reported in 7 publications. Two studies examined detection of anxiety, 8 broadly defined depression (includes HADS-T), 3 strictly defined depression and 7 broadly defined distress. 9 studies involved medical staff and 2 studies nursing staff. Gold standard tools including GHQ60, GHQ12 HADS-T, HADS-D, Zung and SCID. The total sample size was 4786 (median 171).
  13. 13. Testing Clinicians: A Meta-Analysis Results All cancer professionals SE =39.5% and SP =77.3%. Oncologists SE =38.1% and SP = 78.6%; a fraction correct of 65.4%. By comparison nurses SE = 73% and SP = 55.4%; FC = of 60.0%. When attempting to detect anxiety oncologists managed a SE = 35.7%, SP = 89.0%, FC 81.3%. Individual Lecture 2-24June 2009: 9.00am (Category Communication Skills) Sess 13 Lect 3
  14. 14. 1.00 0.90 Post-test Probability PPV NPV 0.80 Doctor 0.458 0.724 0.70 Nurse 0.368 0.852 0.60 0.50 0.40 Nurse Positive 0.30 Nurse Negative Baseline Probability 0.20 Doctor Postive Doctor Negative 0.10 Pre-test Probability 0.00 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 N=10 vs N=2
  15. 15. Cumulative Recognition Cumulative Recognition => Combinations => Combinations
  16. 16. N = 1000 Cancer Population n = 200 n = 800 Depression No Depression Se 70% CNS Assessment Sp 55% Screen #1 Screen #1 +ve -ve PPV 28% NPV 88% TP = 140 TN =440 Possible case FP = 360 Probable Non-Case FN = 60 TN = 440 FP = 360 Se 70% PPV 28% Yield TP = 140 FN = 60 Sp 55% NPV 88%
  17. 17. N = 1000 Cancer Population n = 200 n = 800 Depression No Depression Se 70% CNS Assessment Sp 55% Screen #1 Screen #1 +ve -ve PPV 28% NPV 88% TP = 140 TN =440 Possible case FP = 360 Probable Non-Case FN = 60 Sp 40% Oncologist Assessment Sp 80% Screen #2 Screen #2 +ve +ve PPV 44% NPV 77% TP = 56 TN =288 Probable Depression FP = 72 Probable Non-Case FN = 84 TN = 728 FP = 72 Se 28% PPV 44% Cumulative Yield TP = 56 FN = 144 Sp 91% NPV 83%
  18. 18. Poster session 3 (25 June 2009) Poster category 1 (Communication skills) Poster Nr. 18
  19. 19. Credits & Acknowledgments Elena Baker-Glenn University of Nottingham Paul Symonds Leicester Royal Infirmary Chris Coggan Leicester General Hospital Burt Park University of Nottingham Lorraine Granger Leicester Royal Infirmary Mark Zimmerman Brown University, Rhode Island Brett Thombs McGill University Canada James Coyne University of Pennsilvania For more information www.psycho-oncology.info

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