title: Barriers to the detection and management of depression by palliative care professional carers among their patients: perspectives from professional carers and patients' family members.
abstract: BACKGROUND
  Clinical depression is highly prevalent yet underdetected and poorly managed within palliative care settings.
  
  
  OBJECTIVE
  This qualitative study explored the identification, monitoring, and management of symptoms of depression in patients receiving palliative care from 2 juxtaposed perspectives that are of care providers and care recipients' family members. Examining the barriers that restrict professional carers detecting and managing depression in their patients was a central focus of the study.
  
  
  METHODS
  Focus groups were held with 18 professional carers, including 8 holding managerial positions, across 2 palliative care services, 1 regional and 1 metropolitan, which provided both inpatient and community-based care. Individual interviews were conducted with 10 family members of patients who had received or were receiving palliative care through these services.
  
  
  RESULTS
  Thematic analysis of these data identified that both professional carers and family members perceived that depression is a wide-spread concern for patients receiving palliative care; however, numerous barriers were identified that affect professional carers' ability to identify depression. These included knowledge and training deficits, low self-efficacy, prioritization of physical concerns and time constraints, patient/family characteristics, and system/process issues. These themes (and related subthemes) are discussed in this article.
  
  
  CONCLUSIONS
  Specialized training in depression is recommended for professional carers in order to improve their depression-related knowledge, detection skills, and self-efficacy. The ultimate goal of such training is to increase the rate of recognition of depression that in turn will lead to appropriate treatment for depressed patients.
authors.affiliation: School of Psychology, Deakin University, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Mellor
authors.forename: Marita P
authors.initials: MP
authors.lastname: McCabe
authors.forename: Tanya E
authors.initials: TE
authors.lastname: Davison
authors.forename: Denisa L
authors.initials: DL
authors.lastname: Goldhammer
authors.forename: David J
authors.initials: DJ
authors.lastname: Hallford
mesh_terms: D001315:Australia; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006117:Grief; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000458:organization & administration*; D010465:Perception; D036301:Qualitative Research; D020377:Self Efficacy; D013997:Time Factors