For screening we often use the Hospital Anxiety and Depression Scale (HADS) and if patients are above the cutoff for depression (or anxiety) they ought to be interviewed and if needed a tool like the Beck (BDI) can be more definitive.

For me I find that best data comes from interviewing patients. I have used Grounded Theory data analysis techniques to understand cancer patients quality of life perceptions. GT was originally designed in the 60's to better understand end of life care.

Have a look at this paper that reviews scales for assessing depression in palliative care. Hope this helps.

The following is quoted from Palliative Medicine

http://pmj.sagepub.com/content/early/2010/12/01/0269216310387458

The online version of this article can be found at:

DOI: 10.1177/0269216310387458

Palliat Med published online 12 January 2011

Lauren Rayner, William Lee, Annabel Price, Barbara Monroe, Nigel Sykes, Penny Hansford, Irene J. Higginson and Matthew Hotopf

The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: Cross-sectional survey with four-week follow-up.:-

The baseline survey comprised six measures: the Primary

Care Evaluation of Mental Disorders Patient Health

Questionnaire (PRIME-MD PHQ-9),37 the Brief

Illness Perception Questionnaire (IPQ),38 the Mental

Adjustment to Cancer (MAC) Scale,39 the

Multidimensional Scale of Perceived Social Support,40

The European Organization for Research and

Treatment of Cancer Quality of Life Questionnaire

Version 3 (EORTC-QLQ)41 and The Royal Free interview

for religious and spiritual beliefs.42 Also included

were questions on participants’ satisfaction with the

management of their illness, questions on desire for

death derived from Chochinov43 and questions on dignity

derived from Wilson.44 The follow-up interview

repeated the PRIME-MD PHQ-9, the EORTC-QLQ

and the questions on dignity and desire for death. The

focus of this paper is the presence of depression and the

predictive value of somatic depressive symptoms, which

were assessed using PRIME-MD PHQ-9 and the

EORTC-QLQ-C30. Succeeding papers will utilize data

derived from the other measures to examine associations

and risk factors for depression in palliative care.

The PRIME-MD PHQ-937 is the mood module of

the PRIME-MD, a tool designed to facilitate diagnosis

of common mental disorders in primary care, according

to the criteria of the Diagnostic and Statistical Manual

of Mental Disorders (DSM-IV).30 The PRIME-MD

PHQ-9 assesses the nine DSM-IV criteria for depression.

For each item the patient is asked to indicate

whether they have been bothered by this symptom

‘not at all’, ‘several days’, ‘more than half the days’

or ‘nearly every day’ in the last two weeks. The criteria

for Major Depressive Disorder (MDD) are met if the

patient reports having experienced low mood or loss of

interest plus at least five symptoms in total, for more

than half the days in the last two weeks. ‘Other depressive

syndrome’ is present if the patient has experienced

low mood or loss of interest, and at least two symptoms

in total, for more than half the days in the preceding

two weeks. Suicidal ideation counts towards the diagnosis

if present at all. In order to explore whether physical

symptoms confounded the associations we detected

for depression, we devised an alternative criterion for

PRIME-MD PHQ-9 caseness by excluding items

assessing somatic symptoms (trouble sleeping; feeling

tired; change in appetite; feeling slow or restless). We

termed this the ‘cognitive/affective definition’. Criteria

for this definition were met if the patient reported low

mood or loss of interest plus at least three out of five

cognitive/affective symptoms in total, for more than

half the days in the last two weeks.

The PRIME-MD PHQ-9 offers several advantages

over other methods of assessing depression. It is brief

and easy to administer and is based on standardized,

validated diagnostic criteria. Studies have shown the

PRIME-MD to have satisfactory sensitivity and

specificity to detect depression in primary care,37,45,46

acceptable test–retest reliability,47 and utility as a measure

of change over time.48 Good agreement between

PRIME-MD depression diagnoses and those obtained

through longer diagnostic interviews has been demonstrated

in cancer patients undergoing radiotherapy.49

Validation studies in patients with HIV/AIDS,50

stroke51 and chronic hepatitis C52 also indicate that

the PRIME-MD PHQ-9 is suitable for use in physically

ill patients. The follow-up interview was conducted via

telephone. The validity and reliability of telephone

administration of the PRIME-MD PHQ-9 has been

demonstrated by Pinto-Meza, whose study showed

concordance between telephone and face-to-face

assessments.53

When patients express a firm - as opposed to a passing - desire for Medically Assisted Rational Suicide (MARS), one important marker for the probable absence of depressive illness is their membership or recorded support of a Right-to-Die society for several years, especially if they were in reasonable health at the time they joined. This is good evidence that their desire for MARS - in their home country if legal, in Switzerland if not - is the product of a long held existential world-view and not of a depressive illness. I only do perhaps a dozen assessments a year but am seeing increasing numbers of people with early Alzheimer dementia for whom palliative care, in their view, has nothing to offer and they do not want to put their families through years of gradual and often undignified annihilation of the personality they knew, loved and conversed with about the important things in their lives.

Another reason why such existential views are unlikely to be pathological is that they are evidently held by a large proportion of the white British population. (Williams N, Dunford C, Knowles A, Warner J. Public attitudes to life-sustaining treatments and euthanasia in dementia. Int J Geriatr Psychiatry. 2007 Dec;22(12):1229-34.)

We also use the HADS scale, it's useful to detect depression and anxiety, and since it is very understandable and easy to compile, it is advisable for patients in need of palliation.

These responses are really informative. On issue I wonder about is the extent to which existing tools retain their accuracy in patients with significant cognitive impairment. I think that the HADS in particular experiences reduced accuracy in such folk. Given that cognitive impairments and neurocognitive disorder is so common in palliative care, do we need a tool that specifically addresses this issue?

Hi David

I am sure you are aware my group has looked at this topic extensively but you raise a very interesting question about depression screening in those with cognitive impairment. As you know depression screening has been fairly extensively validated in mild to moderate dementia but rarely in severe dementia or in your area: delirium. the other issue often raised is whether there is contamination from somatic symptoms. We have an unpublished meta-analysis on this plus this primary paper (https://www.ncbi.nlm.nih.gov/pubmed/22310033) which found somatic contamination modest....and related to the point above not confounded by the item "poor concentration" which might give more information on your point about cognition. However this does deserve further study....are you looking into this? regards

We also use the HADS scale, it's useful to detect depression and anxiety, and since it is very understandable

The HADS seems to be used most in research, but I wonder about the GDS for older adults in palliative care. I've used this the most clinically and like the Yes-No format and it does incorporate questions related to illness/cognition.