Screening for depression in advanced disease: psychometric properties, sensitivity, and specificity of two items of the Palliative Care Outcome Scale (POS)

J Pain Symptom Manage. 2015 Feb;49(2):277-88. doi: 10.1016/j.jpainsymman.2014.06.014. Epub 2014 Aug 15.


Context: Depression is common among patients with advanced disease but often difficult to detect.

Objectives: To assess the Palliative care Outcome Scale (POS) (10 items) against the Geriatric Depression Scale (GDS)-10 total score and the Hospital Anxiety and Depression Scale (HADS)-Depression subscale total score and determine if the POS has appropriate items to screen for depression among people with advanced disease.

Methods: This was a secondary analysis performed on five studies. Four psychometric properties were assessed: data quality, scaling assumptions, acceptability, and internal consistency (reliability). Receiver operating characteristic (ROC) curves were used to determine the area under the curve. Sensitivity, specificity, positive and negative predictive values, false positive and negative rates, and positive and negative likelihood ratios were computed.

Results: The overall sample had 416 patients from Germany and England: 144 had cancer and 267 had nonmalignant conditions. Prevalence of depression across the sample was 17.5%. Floor and ceiling effects were rare. Cronbach's alpha coefficients for POS items 7 and 8 summed, GDS-10 and HADS-Depression items varied: 0.61 (heart failure) and 0.80 (cancer). Two items combined (Item 7-feeling depressed and Item 8-feeling good about yourself) consistently presented the highest area under the ROC curve, ranging from 0.76 (95% CI 0.60, 0.93) (Germany, lung cancer) to 0.97 (95% CI 0.91, 1.0) (heart failure), highest negative predictive value, and lowest false negative rate. For the overall sample, the cutoff 2/3 presented a negative predictive value of 89.4% (95% CI 84.7, 92.8) and false negative rate of 10.6 (95% CI 7.2, 15.3).

Conclusion: POS items 7 and 8 summed are potentially useful to screen for depression in advanced disease populations.

Keywords: Palliative care; Palliative care Outcome Scale; advanced disease; clinical practice; cutoffs; depression; end-of-life care; hospice; screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Area Under Curve
  • Cross-Sectional Studies
  • Depressive Disorder / complications
  • Depressive Disorder / diagnosis*
  • England
  • False Positive Reactions
  • Female
  • Germany
  • Humans
  • Male
  • Neoplasms / complications
  • Palliative Care / methods*
  • Psychiatric Status Rating Scales*
  • Psychometrics
  • ROC Curve
  • Reproducibility of Results
  • Sensitivity and Specificity