TY - JOUR
T1 - Implementing collaborative care for major depression in a cancer center
T2 - An observational study using mixed-methods
AU - Walker, Jane
AU - Hobbs, Harriet
AU - Wanat, Marta
AU - Solomons, Luke
AU - Richardson, Alison
AU - Sevdalis, Nick
AU - Magill, Nicholas
AU - Sharpe, Michael
N1 - Funding Information:
The authors would like to thank all the partipating patients and staff of the Oxford University Hospitals NHS Foundation Trust Cancer Centre, as well as Maike van Niekerk, Josie Fielding and Michael Daley for their assistance with data collection for this study. They would also like to thank John Walker and Dorothy Walker for their helpful comments on an earlier version of this manuscript. This work was supported by the UK National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Oxford and Thames Valley at Oxford Health NHS Foundation Trust. Pump-priming for the CC program was provided by Macmillan Cancer Support charity. The SMaRT Oncology trials were funded by Cancer Research UK charity. AR is an NIHR senior investigator. AR's research is supported by the NIHR ARCWessex. NS' research is supported by the NIHR ARC South London at King's College Hospital NHS Foundation Trust. NS is a member of King's Improvement Science, which offers co-funding to the NIHR ARC South London and is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley NHS Foundation Trust), and Guy's and St Thomas' Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The funder had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Funding Information:
The CC program described above has been evaluated in a series of research studies conducted in cancer centers in Scotland, UK. Both the studies and the delivery of the CC program within them, were funded by research grants. The research included the SMaRT Oncology randomized controlled trials. These trials recruited patients attending cancer clinics, who had been diagnosed with major depression by the screening component of the program and for whom DCPC was deemed a suitable treatment (see above). The trial participants were randomly allocated to receive either DCPC or usual care (in which their primary care physician and oncologist were informed of their depression diagnosis and encouraged to treat it).
Publisher Copyright:
© 2022 The Authors
PY - 2022/5/1
Y1 - 2022/5/1
N2 - 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.
AB - 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.
KW - Cancer
KW - Collaborative care
KW - Depression
KW - Implementation
UR - http://www.scopus.com/inward/record.url?scp=85126348709&partnerID=8YFLogxK
U2 - 10.1016/j.genhosppsych.2022.03.003
DO - 10.1016/j.genhosppsych.2022.03.003
M3 - Article
AN - SCOPUS:85126348709
SN - 0163-8343
VL - 76
SP - 3
EP - 15
JO - GENERAL HOSPITAL PSYCHIATRY
JF - GENERAL HOSPITAL PSYCHIATRY
ER -