Implementing collaborative care for major depression in a cancer center: An observational study using mixed-methods

Jane Walker, Harriet Hobbs, Marta Wanat, Luke Solomons, Alison Richardson, Nick Sevdalis, Nicholas Magill, Michael Sharpe*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
59 Downloads (Pure)

Abstract

Objectives: To describe the implementation of a collaborative care (CC) screening and treatment program for major depression in people with cancer, found to be effective in clinical trials, into routine outpatient care of a cancer center. Method: A mixed-methods observational study guided by the RE-AIM implementation framework using quantitative and qualitative data collected over five years. Results: Program set-up took three years and required more involvement of CC experts than anticipated. Barriers to implementation were uncertainty about whether oncology or psychiatry owned the program and the hospital's organizational complexity. Selecting and training CC team members was a major task. 90% (14,412/16,074) of patients participated in depression screening and 61% (136/224) of those offered treatment attended at least one session. Depression outcomes were similar to trial benchmarks (61%; 78/127 patients had a treatment response). After two years the program obtained long-term funding. Facilitators of implementation were strong trial evidence, effective integration into cancer care and ongoing clinical and managerial support. Conclusion: A CC program for major depression, designed for the cancer setting, can be successfully implemented into routine care, but requires time, persistence and involvement of CC experts. Once operating it can be an effective and valued component of medical care.

Original languageEnglish
Pages (from-to)3-15
Number of pages13
JournalGENERAL HOSPITAL PSYCHIATRY
Volume76
Early online date16 Mar 2022
DOIs
Publication statusPublished - 1 May 2022

Keywords

  • Cancer
  • Collaborative care
  • Depression
  • Implementation

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