Stiefel F, Die Trill M, Berney A, Olarte J M, Razavi A
Psychiatry Service, University Hospital Lausanne, Switzerland.
Support Care Cancer. 2001 Oct;9(7):477-88. doi: 10.1007/s005200100244.
Our objective in this study was to summarize the relevant knowledge on depression in palliative care and to provide a framework for clinical, scientific and educational efforts at improving its management. The Research Steering Committee (RSC) of the European Association of Palliative Care (EAPC) established an Expert Working Group (EWG) to address the issue of depression in palliative care. Each invited expert was allocated a specific topic and was asked to review the literature. These reviews were presented during the Sixth Congress of the EAPC in 1999 and then discussed in a closed meeting with members of the RSC. Based on these reviews, and the discussions that followed their presentation, a first draft of the paper was produced and circulated among the invited experts and members of the RSC who had been present at the meetings. After some debate the manuscript was revised, and a second draft was circulated, this time also to RSC members who had not attended the meetings. All persons consulted have agreed on this final version of the report. The EWG concluded that the current level of evidence did not lend itself to the development of clinical guidelines and decided to publish the results of their work as a pragmatic report. The report is divided into four sections, focusing on detection, training and nonpharmacological and pharmacological treatment of depression in palliative care. For each of these sections, general considerations are addressed on the basis of the literature review and of clinical experience and a short description of unresolved issues and recommendations is provided. Underdetection and undertreatment of depression is a serious problem in palliative care. Training of the nonpsychiatric staff should therefore have the highest priority. A proactive, flexible and comprehensive strategy embracing clinical, scientific, and educational aspects is advocated.
我们开展这项研究的目的是总结姑息治疗中有关抑郁症的相关知识，并为改善其管理的临床、科研及教育工作提供一个框架。欧洲姑息治疗协会（EAPC）的研究指导委员会（RSC）成立了一个专家工作组（EWG）来处理姑息治疗中的抑郁症问题。每位受邀专家都被分配了一个特定主题，并被要求查阅文献。这些综述在1999年EAPC第六届大会上进行了展示，随后在与RSC成员的闭门会议中进行了讨论。基于这些综述以及展示后的讨论，形成了论文初稿，并在受邀专家和出席会议的RSC成员中传阅。经过一番辩论后对手稿进行了修订，并分发了第二稿，这次还分发给了未出席会议的RSC成员。所有参与咨询的人员都认可了这份报告的最终版本。EWG得出结论，目前的证据水平不适合制定临床指南，并决定将他们的工作成果作为一份实用报告发表。该报告分为四个部分，重点关注姑息治疗中抑郁症的检测、培训以及非药物和药物治疗。对于每个部分，都基于文献综述和临床经验阐述了一般考虑因素，并对未解决的问题和建议进行了简要描述。在姑息治疗中，抑郁症的漏诊和治疗不足是一个严重问题。因此，对非精神科工作人员的培训应列为最优先事项。提倡采取一种积极主动、灵活且全面的策略，涵盖临床、科研和教育等方面。
