Nursing Homework Paper on Critical Review of Research Studies

Critical Review of Research Studies

Introduction

Hospital anxiety and depression scale can be used as a screening tool for patients with mental disorders and cancer complications. This paper will provide the validity of various proofs regarding the performance and accuracy of the Hospital Anxiety and Depression Scale on cancer patients. In particular, the paper will examine the usefulness of this screening tool on patients with metastatic cancer and depressive disorders. The paper will use examine the research done to indicate the specificity and sensitivity of the patients to the screening tool. The paper will examine various controversies and shortcomings of each research tool to guide in useful decision making.

Validity of the Hospital Anxiety and Depression Scale as a Screening Tool in Patients with Advanced Metastatic Cancer

The main issue presented in this research finding is whether the use of Hospital Anxiety and Depression Scale as a screening tool for metastatic cancer patients is hygienic. The study involves metastatic cancer patients between the ages of 18 and 70. In a sample of one hundred patients receiving palliative treatments, 68 percent responded poorly to the screening methodology. The sensitivity of all the patients towards the anxiety and depression scale implied that its use was ineffective in offering treatments to metastatic cancer patients. The anxiety subscale indicated a specificity of 68 percent and sensitivity levels of 59 percent. Also, the results had a positive predictive value of 75 percent which declined with anxiety levels. The validity of these study findings presents a controversy over its usefulness in treatment of metastatic cancer patients.

The major controversy was that cases of depressive illnesses increases with age and thus the screening criteria may not offer the best results for underage population. Thus, Hospital Anxiety and Depression Scale should be combined with other scales to achieve better outcomes. The shortcomings of this research are that it may fail to offer treatments from terminally ill patients. To ensure that the scale is useful, a number of cutoff thresholds should be selected and weighed against each score.  Each threshold should be analyzed individually based on anxiety and depression levels of the patient age. All variances noted should be used in measuring the validity of the scale and the homogeneity of the outcomes (Lloyd-Williams, Friedman, & Rudd, 2001).

Validity of Screening for Depression in Terminally Ill Cancer Patients in Japan

The main issue in this analysis is whether screening is recommended for terminally ill cancer patients in Japan. The study evaluated the performance of various screening tools such Hospital Anxiety and Depression Scale for major depression patients and adjustment disorders. In response to the increasing suicidal and psychological distress in terminally ill cancer patients in Japan, the study was carried from highly susceptible populations. Two hundred and nine patients were interviewed on a structured panel at the cancer care units.  Screening focused on the sensitivity, specificity and predictive values of the patients (Akechi, Okuyama, Sugawara, Shima, Furukawa, & Uchitomi, 2006).

The results indicated sensitivity levels of 0.79 percent and specificity of 0.75. An alternative criterion involved two single item interviews in which the patients were required to give responses with regard to their depression states. In both cases, the patients were sensitive to the screening instruments. However, the findings suggest that Hospital Anxiety and Depression Scale were better screening criteria for an aged population. The shortcomings of this research finding are that screening of terminally ill patients by hospital anxiety and depression scales does not give maximum benefits. In particular, screening for depression involves many other factors outside the scope of the screening. Understanding the individual patient’s problem is important for effective screening.

Validity of the Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients

            The theme of this analysis is to assess the performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients. The analysis examined the sensitivity and specialty of various Hospital Anxiety and Depression Scale cut-off scores on cancer patients. In the analysis, a combination of questionnaire and interviews were conducted on patients in outpatient clinics in Edinburgh, Scotland and Great Britain. From the 361 patients interviewed, only 30 patients qualified for the major depressive disorder criteria. The sensitivity of the patients towards the screening criteria was high especially to the older population (Walker, Postma, McHugh, Rush, Coyle, Strong, & Sharpe, 2007).  

The results of the finding indicated that a cutoff of 14/15 achieved 95 percent sensitivity, with a positive predictive value of 0.35. Also, the specificity of the outcome stood at 95 percent. The conclusions of this research finding were that Hospital Anxiety and Depression Scale are useful screening criteria for outpatients in mixed cancer care centers. The controversies of this screening method are that it is limited in its application. For example, only patients above the set cutoff can participate in the screening interview. Also, it is not possible to carry out the diagnosis especially where the numbers of patients are numerous. Several questions remain unanswered on the application of hospital anxiety and depressive disorder in depressive cancer patients. Firstly, Hospital Anxiety and Depression Scale is limited to specific diagnostic situations. Thus it cannot validate results of numerous psychiatric diagnoses.

Validity of Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients

The issues presented in this case were whether the use of Hospital Anxiety and Depression Scale provided accurate results to cancer patients. The research focused on evaluating the meta-aspects of the screening and systematic review. This research differed from other research methodologies in that it did not rely on pre-set cutoffs. In the analysis, various databases were compared with the Hospital Anxiety and Depression Scale to act as a reference for standardizing screening for mental and depressive disorders (Vodermaier, & Millman, 2011). Also, separate analyses were carried out for single and multiple thresholds.

The screening indicated sensitivity levels of 0.80 and specificity of 0.74 on the Hospital Anxiety and Depression Scale. On the anxiety subscale, a sensitivity of 0.87 and specificity of 0.85 were noted. In both cases, there was a strong correlation between sensitivity and specificity. The conclusions of this screening indicated that diagnostic accuracy varied under different criteria. Also, depression screening was more superior for cancer patients than other mental disorders. The research conclusion suffers from various shortcomings. The evaluation criteria are based on statistical rather than content considerations. Under normal circumstances, sensitivity and specificity are inversely related. Thus, the scope of the meta-analysis cannot be accurately interpreted and compared when different thresholds are used.

Validity of the Screening for mental disorders by standardized clinical interview

The theme for this research was to examine the validity of the use of standardized clinical interviews for mental disorders. The research examined the use usefulness of Hospital Anxiety and Depression Scale and the General Questionnaire on mental disorder cases. 188 cancer patients in total were assessed for psychological distress. Consequently, they were diagnosed for mental disorders by standardized interviews. The validity of the two instruments was assessed based on factors such as anxiety levels, depression and multiple mental disorders.

In the analysis, Hospital Anxiety and Depression Scale had better performance than the General Questionnaire for detection of depressive disorders. The results indicated a sensitivity of 0.79 percent with a specificity percentage of 76 (Reuter & Härter, 2001). The conclusions of this research finding s showed that Hospital Anxiety and Depression Scale were valid screening criteria for mental disorders in cancer patients. The limitations of this screening criterion are that it applies different methodological approaches in diagnosis. Also, it cannot provide accurate results for terminally ill patients.

Validity of the Comparison of the Hospital Anxiety and Depression Scale and the Center for Epidemiological Studies Depression Scale for detecting depression in women with breast or gynecologic cancer

The aim of this research was to investigate the usefulness of Hospital Anxiety and Depression Scale on depression on women with Brest Cancer.  The sample comprised of women in major teaching hospitals in Australia.  The study examined the variances of cases of depression on women of different ages. The sensitivity among the young women was low at 76.9 percent and specificity of 77 percent in comparison to older women with sensitivities of 81 percent and 83 percent respectively. The conclusions of this research finding showed that Hospital Anxiety and Depression Scale were valid screening criteria for women with breast cancer (Stafford, Judd, Gibson, Komiti, Quinn, & Mann, 2014). The correlation between age and prevalence cases indicated a strong relationship. The strengths of this performance screening criteria was invalidated on the basis that there were unnoticeable differences between patients subjected to screening and those who did not.

Conclusions

 In summary the results of these findings have indicated that the use of hospital anxiety and depressive disorders is a useful tool in screening cancer patients especially in mild cases. In all the research findings, a high sensitivity factor was noted which indicated the responses of the patients. However, the use if Hospital Anxiety and Depression Scale should be integrated with other screening methodologies to present valid results. These include the use of General Questionnaire techniques and incorporating different criteria of diagnosis simultaneously. For terminally ill patients, the Hospital Anxiety and Depressive Scale may fail to give accurate results if singly used. Thus, an integration of different screening criteria should be encouraged for valid results.

References

Akechi, T., Okuyama, T., Sugawara, Y., Shima, Y., Furukawa, T. A., & Uchitomi, Y. (2006). Screening for depression in terminally ill cancer patients in Japan. Journal of pain and symptom management, 31(1), 5-12.

Lloyd-Williams, M., Friedman, T., & Rudd, N. (2001). An analysis of the validity of the Hospital Anxiety and Depression scale as a screening tool in patients with advanced metastatic cancer. Journal of pain and symptom management, 22(6), 990-996.

Reuter, K., & Härter, M. (2001). Screening for mental disorders in cancer patients–discriminant validity of HADS and GHQ‐12 assessed by standardized clinical interview. International Journal of Methods in Psychiatric Research, 10(2), 86-96.

Stafford, L., Judd, F., Gibson, P., Komiti, A., Quinn, M., & Mann, G. B. (2014). Comparison of the Hospital Anxiety and Depression Scale and the Center for Epidemiological Studies Depression Scale for detecting depression in women with breast or gynecologic cancer. General hospital psychiatry, 36(1), 74-80.

Vodermaier, A., & Millman, R. D. (2011). Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: a systematic review and meta-analysis. Supportive care in cancer, 19(12), 1899-1908.

Walker, J., Postma, K., McHugh, G. S., Rush, R., Coyle, B., Strong, V., & Sharpe, M. (2007). Performance of the Hospital Anxiety and Depression Scale as a screening tool for major depressive disorder in cancer patients. Journal of psychosomatic research, 63(1), 83-91.