It is widely recognised that depression is not detected and therefore not treated in patients who are terminally ill. It is difficult to distinguish depression from sadness at the end of life and many of the criteria for diagnosing depression are not appropriate in the terminally ill patient. There has been considerable interest in using screening tools at the time of referral or admission to a hospice, but to date none of these have been validated for use in palliative care patients. This pilot study of 25 patients admitted to a hospice found that a 100-mm linear visual analogue scale (VAS) correlated well with both the depression sub scale and total score of the Hospital Anxiety and Depression Scale (HADS) and was found to be quick and easy to complete by most patients. The finding suggest that the VAS may be useful as a screening tool for depression in patients with advanced metastatic disease and that larger studies comparing VAS to clinical psychiatric interviews should be undertaken.