Depression in advanced physical illness: diagnostic and treatment issues.

Assessing and managing depression and other forms of psychological distress in patients with advanced physical illness (such as advanced cancer) can be complex clinical tasks. Assessment of distress is complicated by the contribution of the physical disease and side effects of its treatment to symptoms. Clinical evidence has indentified factors that increase vulnerability to experiencing distress and interventions that can improve wellbeing in patients with serious physical illness, yet there are significant gaps in current practice and challenges for health professionals in addressing the core emotional concerns of patients with advanced physical illness. The 2003 publication Clinical practice guidelines for the psychosocial care of adults with cancer provides evidence-based recommendations for providing psychosocial care. Implementing existing guidelines, including systematic assessment of risk and adapting interventions to reflect the precise needs of patients, requires strategies to help clinicians in the emotional dimensions of this caring role.