Acceptability of common screening methods used to detect distress and related mood disorders-preferences of cancer specialists and non-specialists.

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.