title: Expert opinion on detecting and treating depression in palliative care: A Delphi study.
abstract: BACKGROUND
  There is a dearth of data regarding the optimal method of detecting and treating depression in palliative care. This study applied the Delphi method to evaluate expert opinion on choice of screening tool, choice of antidepressant and choice of psychological therapy. The aim was to inform the development of best practice recommendations for the European Palliative Care Research Collaborative clinical practice guideline on managing depression in palliative care.
  
  
  METHODS
  18 members of an international, multi-professional expert group completed a structured questionnaire in two rounds, rating their agreement with proposed items on a scale from 0-10 and annotating with additional comments. The median and range were calculated to give a statistical average of the experts' ratings.
  
  
  RESULTS
  There was contention regarding the benefits of screening, with 'routine informal asking' (median 8.5 (0-10)) rated more highly than formal screening tools such as the Hospital Anxiety and Depression Scale (median 7.0 (1-10). Mirtazapine (median 9 (7-10) and citalopram (median 9 (5-10) were the considered the best choice of antidepressant and cognitive behavioural therapy (median 9.0 (3-10) the best choice of psychological therapy.
  
  
  CONCLUSIONS
  The range of expert ratings was broad, indicating discordance in the views of experts. Direct comparative data from randomised controlled trials are needed to strengthen the evidence-base and achieve clarity on how best to detect and treat depression in this setting.
authors: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, UK. Lauren.Rayner@kcl.ac.uk.
authors: Lauren
authors: L
authors: Rayner
authors: Annabel
authors: A
authors: Price
authors: Matthew
authors: M
authors: Hotopf
authors: Irene J
authors: IJ
authors: Higginson
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