Depression is common: it affects one-quarter of those in palliative care.1 2 It may be associated with suicidal ideation or may have repercussions for treatment decision-making. Anxiety and depression are treatable (even in this population) with remission rates of >50% at 4 weeks.1 Depression is associated with reduced quality of life (QoL) and increased mortality, and along with anxiety, is an important target symptom for intervention.3 They are frequently underdetected and undertreated in palliative care.4

Detection may be difficult due to diagnostic overshadowing—somatic symptoms may arise from depression, high symptom burden or even treatment side effects. The European Clinical Guidelines for the Management of Depression in Palliative Care emphasises screening and a high clinical suspicion for anxiety and depression, given their prevalence.5 They recommend the Hospital Anxiety and Depression Scale (HADS) to screen for depression, as it has minimal focus on somatic symptoms.5

In a pilot study, we examined the acceptability of the HADS, along with a brief QoL measure, to screen for anxiety and depression across both hospital and …