Mitchell Alex J, Kaar Stephen, Coggan Chris, Herdman Joanne
Liaison Psychiatry, University of Leicester, Brandon Unit, Leicester, UK.
Psychooncology. 2008 Mar;17(3):226-36. doi: 10.1002/pon.1228.
A new questionnaire of clinicians' attitudes and practices in relation to screening for mood disorder was distributed to 300 cancer professionals (specialists and non-specialists) working across the UK. From 226 (75.3%) health professionals working in cancer care who responded, approximately two-thirds always or regularly attempted to detect mood disorder during consultations but a substantial minority relied on patients spontaneously mentioning an emotional issue. The highest rate of routine questioning was performed by clinicians working in palliative medicine (76.3%) as well as nurse specialists working in all areas (72%). Despite these relatively high rates of enquiry, 10% or less of all specialists used a validated questionnaire, most preferring to rely on their own clinical skills or recalling the two simple questions of the short Patient Health Questionnaire (PHQ2). Staff suggested that ideal screening practice was to use one, two or three simple questions or a short validated questionnaire but not to refer to a specialist for a diagnosis. The main barrier to successful screening was lack of time but insufficient training and low confidence were also influential. Once distress was detected, 90% of nurses but only 40% of doctors were prepared to give distressed patients as much time as they needed. Predictors of clinicians' willingness to use more advanced screening methods were length of follow-up appointments and time clinicians were prepared to spend detecting distress. We suggest that future field studies of screening tools should also measure the issue of acceptability.
一份关于临床医生在情绪障碍筛查方面的态度和做法的新问卷被分发给了全英国300名癌症专业人员（专科医生和非专科医生）。在回复问卷的226名（75.3%）从事癌症护理工作的卫生专业人员中，约三分之二的人在会诊时总是或经常试图检测情绪障碍，但相当一部分人依赖患者自发提及情绪问题。在姑息医学领域工作的临床医生（76.3%）以及所有领域的护士专科医生（72%）进行常规询问的比例最高。尽管询问率相对较高，但所有专科医生中只有10%或更少的人使用经过验证的问卷，大多数人更愿意依靠自己的临床技能或回忆简短的患者健康问卷（PHQ2）中的两个简单问题。工作人员建议，理想的筛查做法是使用一、两个或三个简单问题或一份简短的经过验证的问卷，而不是转诊给专科医生进行诊断。成功筛查的主要障碍是时间不足，但培训不足和信心不足也有影响。一旦发现患者有困扰，90%的护士愿意给予困扰患者所需的时间，但只有40%的医生愿意这样做。临床医生愿意使用更先进筛查方法的预测因素是随访预约的时长以及临床医生准备用于检测困扰的时间。我们建议，未来筛查工具的实地研究也应衡量可接受性问题。
