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

Area of Science:

• Oncology
• Psychiatry
• Healthcare Implementation Science

Background:

• Major depression is prevalent in cancer patients.
• Collaborative care (CC) models have shown efficacy in clinical trials for treating depression in this population.
• Transitioning evidence-based programs into routine clinical practice presents unique challenges.

Purpose of the Study:

• To describe the implementation process of a CC screening and treatment program for major depression in cancer patients.
• To evaluate the feasibility and effectiveness of integrating this program into standard outpatient cancer care.

Main Methods:

• A mixed-methods observational study utilizing the RE-AIM implementation framework.
• Data collection spanned five years, incorporating both quantitative and qualitative measures.
• The study tracked patient participation, treatment engagement, and depression outcomes.

Main Results:

• Implementation required three years and substantial expert involvement, with initial barriers including program ownership ambiguity and organizational complexity.
• High patient participation in depression screening (90%) and significant treatment attendance (61%) were observed.
• Depression treatment response rates (61%) mirrored clinical trial benchmarks, and long-term funding was secured after two years.

Conclusions:

• Successful implementation of CC for major depression in cancer care is achievable but demands sustained effort and expert collaboration.
• The program, once established, becomes an effective and valued component of comprehensive cancer care.
• Ongoing support and clear integration strategies are crucial for long-term success.