Implementation of Depression Screening with the Patient Health Questionnaire-9 (PHQ-9) at a Radiation Oncology Department.

Abstract

Introduction Depression is the leading cause of disease burden and disability in adults in the United States and worldwide. Cancer patients with unidentified and/or untreated depression are at increased risk for adverse health outcomes that contribute to poor prognosis and mortality. Inadequate depression screening and referral practices were observed and verbalized as a concern by internal stakeholders at a Radiation Oncology Department (ROD). Retrospective chart audits revealed depression screening compliance was less than two percent. Thus, the purpose of this Quality Improvement (QI) project was to implement and evaluate the Patient Health Questionnaire (PHQ-9) depression screening tool with subsequent psychosocial referrals for all positive screens. It is anticipated these interventions will improve early identification of depression in adult cancer patients and increase patient access to psychosocial services for formal evaluation. Methods There is considerable evidence of the high internal consistency, reliability and validity with the PHQ-9. Eligible adult cancer patients at the ROD were screened for depression with the PHQ-9 during their first treatment visit. Patients with positive screens (score of ≥10) were provided resources and referred to an Oncology Social Worker for further evaluation. Weekly retrospective chart reviews were conducted to collect the number and percentage of completed PHQ-9 screening and referrals. Staff compliance results were summarized in frequency counts and plotted on run charts to monitor implementation progress. Results A total of 117 cancer patients attended their first treatment appointment. Of these, 61% (n=71) were screened for depression with the PHQ-9 instrument, and 13% screened positive for depression. Of those positive screens (n=9), 100% were referred to the Oncology Social Worker, and 100% received follow-up care. Staff pre/post-education survey data were analyzed statistically with a Wilcoxon signed-rank test. The results demonstrated improved competency in the new process (V = 17.00, z = -6.31, p < .001). Conclusions After fifteen weeks of data collection and analysis, the plan is to discuss the brevity, efficacy, and feasibility of the PHQ-9 depression screening and psychosocial referrals for cancer patients undergoing radiotherapy at the ROD. The impact of the practice change, significance of results, and sustainability measures will also be covered. Depression is the leading cause of disease burden and disability in adults in the United States and worldwide. Cancer patients with unidentified and/or untreated depression are at increased risk for adverse health outcomes that contribute to poor prognosis and mortality. Inadequate depression screening and referral practices were observed and verbalized as a concern by internal stakeholders at a Radiation Oncology Department (ROD). Retrospective chart audits revealed depression screening compliance was less than two percent. Thus, the purpose of this Quality Improvement (QI) project was to implement and evaluate the Patient Health Questionnaire (PHQ-9) depression screening tool with subsequent psychosocial referrals for all positive screens. It is anticipated these interventions will improve early identification of depression in adult cancer patients and increase patient access to psychosocial services for formal evaluation. There is considerable evidence of the high internal consistency, reliability and validity with the PHQ-9. Eligible adult cancer patients at the ROD were screened for depression with the PHQ-9 during their first treatment visit. Patients with positive screens (score of ≥10) were provided resources and referred to an Oncology Social Worker for further evaluation. Weekly retrospective chart reviews were conducted to collect the number and percentage of completed PHQ-9 screening and referrals. Staff compliance results were summarized in frequency counts and plotted on run charts to monitor implementation progress. A total of 117 cancer patients attended their first treatment appointment. Of these, 61% (n=71) were screened for depression with the PHQ-9 instrument, and 13% screened positive for depression. Of those positive screens (n=9), 100% were referred to the Oncology Social Worker, and 100% received follow-up care. Staff pre/post-education survey data were analyzed statistically with a Wilcoxon signed-rank test. The results demonstrated improved competency in the new process (V = 17.00, z = -6.31, p < .001). After fifteen weeks of data collection and analysis, the plan is to discuss the brevity, efficacy, and feasibility of the PHQ-9 depression screening and psychosocial referrals for cancer patients undergoing radiotherapy at the ROD. The impact of the practice change, significance of results, and sustainability measures will also be covered.