Psychiatric morbidity and its recognition by doctors in patients with cancer

Psychiatric morbidity in patients with cancer is high and without appropria te treatment unremitting. We assessed the ability of 143 doctors to establi sh the psychological status of 2297 patients during outpatient consultation s in 34 cancer centres and hospitals in the UK. Prior to seeing the doctor, consenting patients completed a short self-report questionnaire (GHQ12), d esigned for the psychological screening of large populations. At the end of the consultation, doctors completed visual analogue scales rating patients ' distress. 837/2297 (36.4%) patients had GHQ scores suggestive of psychiat ric morbidity. The doctors' sensitivity (true positive rate) was 28.87% (SD 25.29), specificity (true negative rate) 84.79% (SD 17.44). The misclassif ication rate was 34.7% (SD 13.79) meaning that for 797 patients the wrong a ssessment was probably made. These data show that much of the probable psyc hiatric morbidity experienced by patients with cancer goes unrecognized and therefore untreated. Doctors need communication skills training to elicit problems during consultations. Appropriate referrals to psychological servi ces are necessary when patients requiring help are identified and ought to be an integral part of cancer care. (C) 2001 Cancer Research Campaign.