Depression in palliative care: a pragmatic report from the expert working group of the European Association for Palliative Care

Our objective in this study was to summarize the relevant knowledge on depr ession in palliative care and to provide a framework for clinical, scientif ic and educational efforts at improving its management. The Research Steeri ng Committee (RSC) of the European Association of Palliative Care (EAPC) es tablished an Expert Working Group (EWG) to address the issue of depression in palliative care. Each invited expert was allocated a specific topic and was asked to review the literature. These reviews were presented during the Sixth Congress of the EAPC in 1999 and then discussed in a closed meeting with members of the RSC. Based on these reviews, and the discussions that f ollowed their presentation, a first draft of the paper was produced and cir culated among the invited experts and members of the RSC who had been prese nt at the meetings. After some debate the manuscript was revised, and a sec ond draft was circulated, this time also to RSC members who had not attende d the meetings. All persons consulted have agreed on this final version of the report. The EWG concluded that the current level of evidence did not le nd itself to the development of clinical guidelines and decided to publish the results of their work as a pragmatic report. The report is divided into four sections, focusing on detection, training and nonpharmacological. and pharmacological treatment of depression in palliative care. For each of th ese sections, general considerations are addressed on the basis of the lite rature review and of clinical experience and a short description of unresol ved issues and recommendations is provided. Underdetection and undertreatme nt of depression is a serious problem in palliative care. Training of the n onpsychiatric staff should therefore have the highest priority. A proactive , flexible and comprehensive strategy embracing clinical, scientific, and e ducational aspects is advocated.