Screening for Distress and Depression vs Optimizing Support and Compassion in Medical Care

My upcoming talks at the Dutch International Congress on Insurance Medicine 2017

screening bookOn Thursday November 9, 2017  I am  pleased to be presenting two talks at the Dutch Society for Insurance Medicine (NVVG) and the Dutch Association of Medical Officers in Private Insurances (GAV) 9th Annual Congress, international day in English on Thursday 9th November 2017.

The Congress is intended for medical officers, insurance and occupational health physicians and others interested in this particular field. Approximately 350 medical doctors in insurance medicine and social benefits are expected to attend. The congress is described as highly appreciated by the participants, and many outstanding and inspiring speakers have contributed over the past years.

I am very pleased to be having another opportunity to present my updated views on screening for depression and distress, as well as whether screening is the optimal way to provide support and compassion in busy routine medical care. Those who are familiar with my work are aware of my skepticism that routine screening improves patient outcomes.

Congress venue:

Van der Valk Hotel Almere

Veluwezoom 45

1327 AK Almere

The Netherlands

Thursday, November 9, 201

9:15- 10:00 Plenary Speaker

The optimal way of providing psychosocial care and care for depression to medical patients

Summary

Provision f routine psychosocial care to medically ill patients can be negatively impacted by assuming that basic supportive care needs are primarily mental health issues. Management of depression poses distinct challenges. Care for chronic and acute medical conditions can create competing demands and  disrupt existing care  for depression. Much co-occurring depression apparent during medical care is among patients represents recurrences with recent or past depression care. Much depression care initiated during medical treatment is with inadequate diagnosis, monitoring, and follow up. Optimization of care depends on recognizing depression is largely a chronic, episodic condition with variable course and incomplete remission. The management of depression care can become out of sync with the course of patients’ depression.

14:40- 15:15 Round 1: Parallel sessions

Screening for distress and procedures versus routine compassion in cancer care

Summary

Screening for distress among cancer is increasingly mandated internationally without regard to the character of existing health systems and psychosocial care. A lack of robust evidence that screening for distress actually improves patient outcomes is being ignored. The invented concept of “distress” does not map well onto distinct sources of patient discomfort and unmet needs. Depending on the health system, introduction of routine screening can tax existing supportive care and uncover needs that  supportive services cannot address. Access to affordable, accessible care consistent with patient preferences is more challenging that detecting ambiguous “distress” among cancer patients. In moderate to high functioning health systems, exisiting provision of supportive and compassionate care can be disrupted by introduction of screening with a greater emphasis on billable procedures and risk of unnecessary treatment.

Readings

Here are a couple of relevant past blog post that you can expect will be updated in my talks:

Where’s the evidence that screening for distress benefits cancer patients? 

Distress- the 6th vital sign for cancer patients?

Psychosocial care focuses too much on young, attractive patients successfully coping with cancer. https://www.coyneoftherealm.com/blogs/mind-the-brain/psychosocial-care-focuses-too-much-on-young-attractive-patients-successfully-coping-with-cancer

And a key review paper with an outstanding group of co-authors:

Thombs BD, Coyne JC, Cuijpers P, De Jonge P, Gilbody S, Ioannidis JP, Johnson BT, Patten SB, Turner EH, Ziegelstein RC. Rethinking recommendations for screening for depression in primary care. Canadian Medical Association Journal. 2012 Mar 6;184(4):413-8.