A patient centred approach to measuring outcomes in psycho-oncology services: The PHQ-8 as a viable alternative to the PHQ-9.

Demonstrating both quality and outcomes in health services ensures patients receive care that is safe, effective, patient‐centred, timely, efficient, and equitable. Quality addresses the clinical and operational aspects of care, alongside patient experience. Outcomes typically refer to the measurement of an intervention's impact. Within psychological services, this is often demonstrated through standardised patient reported outcome measures (PROMs). There is no agreed standard for measuring outcome in UK psycho‐oncology services. In 2015, the British Psychological Society published guidance to such services, proposing a network‐level multifactorial approach, that uses a combination of PROMs with normative data from UK cancer populations, that do not place undue burden on patients. Whilst there is variability in PROMs used, the Patient Health Questionnaire‐9 (PHQ‐9), a reliable and valid tool for measuring depressive symptomatology in the cancer population, has been widely adopted. Psycho‐oncology services within North Central and East London have worked together to develop a system wide approach to measuring outcomes.During a reviewof our approach in 2018,we held a focus group to glean service users' views on eight commonly used, standardisedPROMs.We invited service userswhohad received some form of psychological care from our regional psycho‐oncology services to participate; 10 participated. Across all the questionnaires considered, Item‐9 from thePHQ‐9 (‘Thoughts that youwould be better off dead or of hurting yourself in some way’) received the most consistent criticism. Participants described the question as ‘insensitive’, ‘brutal’, and ‘jarring’ in the context of a life‐threatening illness. Additionally, they were confused about what the question was asking (referring to suicidality or self‐harm) and expressed concerns that endorsing such an item may cause them to be labelled as mentally ill by their cancer teams. They understood that some people may have thoughts around suicide or self‐harm, but thought these would be better addressed in a different way, not included in a questionnaire. As this focus group was part of a service evaluation, participants were not asked for personal details, including the reason they had received care from a psycho‐ oncology services or whether they had previously reported suicidality. Whilst the wide spread clinical utility of, and familiarity with, the PHQ‐9 in the UK has been a strong rationale for its continued use,