Tailored Strategies Can Up Depression Referrals in Breast Cancer

For patients with newly diagnosed breast cancer, tailored strategies for implementation of routine depression screening result in a greater proportion of referrals to behavioral care, according to a study published in the Jan. 4 issue of the Journal of the American Medical Association.

Eric E. Hahn, Ph.D., M.P.H., from Kaiser Permanente Southern California in Pasadena, and colleagues examined the effectiveness of an implementation strategy-guided depression screening program in a trial conducted at six medical centers with 1,436 patients diagnosed with new primary breast cancer. The centers were randomly assigned to either tailored implementation strategies (three sites; 744 patients) or education-only (three sites; 692 patients). The program consisted of 9-item Patient Health Questionnaire screening and algorithm-based scoring and referral to behavioral health services; at tailored intervention sites, clinical teams received program education, audit, and feedback of performance data and implementation facilitation.

The researchers found that 7.9 and 0.1 percent of patients at tailored sites and education-only sites, respectively, were referred. Referrals to a behavioral health clinician were completed by 44 of 59 (75 percent) and one of one patient at the intervention and education-only sites, respectively. Patients at tailored sites had significantly fewer outpatient visits in medical oncology in adjusted models (rate ratio, 0.86); no differences were seen in utilization of primary care, urgent care, or emergency department visits.

"Tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care," the authors write. "Further research is needed to understand the clinical benefit and cost-effectiveness of this program."