Clinical assessment of emotions in patients with cancer: Diagnostic accuracy compared to two reference standards.

Abstract

24 Background: Previous research has suggested that clinical assessment of emotions in patients with cancer is suboptimal. Since well-trained and experienced doctors and nurses may differentiate between emotions that do or do not necessitate professional mental health care, we hypothesized that clinical assessment may be more accurate than previously concluded. This study aimed to evaluate the diagnostic accuracy of clinical assessment of emotions. Methods: The study was designed as a retrospective cohort study at a department of medical oncology. The clinical assessment of emotions by medical oncologists and nurses was derived from the patient file. Emotional distress and need for emotional care was assessed using the Distress Thermometer and Problem List. The sensitivity, specificity and diagnostic odds ratio of clinical assessment was calculated, with either (i) emotional distress or (ii) need for professional mental health care as a reference standard. Results: Clinical assessment resulted in notes on emotions in 42.2% of the patient files (n =185), with 36.2% of patients experiencing emotional distress and 10.8% expressing a need for professional mental health care. As expected, the sensitivity of clinical assessment of emotions was higher with ‘need for professional mental health care’ as reference standard, compared to ‘emotional distress’ as reference standard (0.85 versus 0.54, p < 0.001). The diagnostic odds ratio showed a similar pattern (9.66 versus 2.10, p = 0.02). For specificity, equivalent results were obtained with the two reference standards (0.63 versus 0.64, p =0.63). Conclusions: Medical oncologists and nurses seem to differentiate between emotions that do or do not necessitate professional mental health care, resulting in a high sensitivity of clinical assessment of emotions in patients with cancer.