King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK.
Int J Nurs Stud. 2012 Dec;49(12):1480-8. doi: 10.1016/j.ijnurstu.2012.07.016. Epub 2012 Aug 11.
Hepatitis C virus (HCV) affects 170 million worldwide. Currently, around 30% of patients receiving interferon-alpha (IFN-α) treatment for HCV experience clinically significant depression. Effective and timely detection of depression is crucial to ensuring appropriate treatment and support. However, little is known about how clinical nurse specialists identify patients at risk of developing interferon-alpha-induced depression, and monitor those receiving antiviral treatment for the occurrence of depression.
This study aimed to gain an in-depth understanding of staff experience of, and attitudes towards, the identification and monitoring of interferon-alpha-induced-depression and the decision-making process concerning the use of liaison psychiatry and other clinical services.
A qualitative interview study was conducted among clinical staff involved in the care of patients with hepatitis C, using the perspective of naturalistic decision making.
Outpatient liver clinics in three large teaching hospitals in South London, the United Kingdom.
All clinical nurse specialists from the three outpatient liver clinics were included. All were involved directly in the care of patients receiving interferon-alpha treatment and had at least one year experience (mean 6.4 years, range 1-11 years) in this field.
Semi-structured face-to-face interviews were conducted between 2010 and 2011. Data collection and analysis were carried out iteratively to ensure the reliability of the analysis using the constant comparison method.
Staff used verbal and non-verbal cues when assessing risks of patients developing depression before and during IFN-α treatment. Major sources of uncertainty were patient engagement and familiarity, referrals to psychiatrists, language barriers, and distinguishing between psychological and physical symptoms. Good rapport with patients and good communication among multidisciplinary professional groups were key strategies identified to reduce uncertainty.
Current methods of identifying vulnerable patients rely on the availability of clinical experts and good communication within a multidisciplinary team. Detection and management of depression in this population is complex, however, various strategies are employed by nurses to overcome difficulties when making decisions regarding patient welfare. Current clinical practices should be taken into account when developing new tools and methods.
丙型肝炎病毒（HCV）影响全球 1.7 亿人。目前，约 30%接受干扰素-α（IFN-α）治疗 HCV 的患者出现临床显著抑郁。有效和及时地发现抑郁对于确保适当的治疗和支持至关重要。然而，对于临床护士专家如何识别有发生干扰素-α诱导性抑郁风险的患者，以及监测接受抗病毒治疗的患者出现抑郁的情况，人们知之甚少。
本研究旨在深入了解工作人员对识别和监测干扰素-α诱导性抑郁的经验和态度，以及关于使用联络精神病学和其他临床服务的决策过程。
采用自然决策视角，对参与丙型肝炎患者护理的临床工作人员进行定性访谈研究。
英国伦敦南部三家大型教学医院的门诊肝脏诊所。
所有三家门诊肝脏诊所的临床护士专家均纳入研究。所有专家均直接参与接受干扰素-α治疗的患者护理，且在该领域至少有 1 年的经验（平均 6.4 年，范围 1-11 年）。
2010 年至 2011 年期间进行半结构化面对面访谈。使用恒定比较法进行数据收集和分析的迭代，以确保分析的可靠性。
工作人员在 IFN-α治疗前和治疗期间评估患者发生抑郁的风险时，使用了言语和非言语线索。主要的不确定性来源包括患者的参与度和熟悉度、向精神科医生的转诊、语言障碍以及区分心理和身体症状。与患者建立良好的关系和多学科专业团队之间的良好沟通是确定的关键策略，可以减少不确定性。
目前识别易患患者的方法依赖于临床专家的可用性和多学科团队内部的良好沟通。然而，护士在为患者福利做出决策时，会采用各种策略来处理该人群中抑郁的检测和管理的复杂性。在开发新工具和方法时，应考虑当前的临床实践。
