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Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project.

Daniel Shalev1, Melissa Patterson2, Yasemin Aytaman3

  • 1Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine (D.S., M.D.S., M.C.R.), New York, New York, USA.

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|September 14, 2022
PubMed
Summary

Implementing depression screening using the Patient Health Questionnaire-2 (PHQ-2) in palliative care increased screening rates significantly. Clinicians found the process feasible and acceptable, improving patient care.

Keywords:
Depressionpalliative carepsychiatrypsychooncologyscreening

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Area of Science:

  • Palliative Care Medicine
  • Quality Improvement Science
  • Psychiatric Screening

Background:

  • Depression is prevalent in palliative care settings, significantly affecting patient outcomes.
  • Operationalized depression screening is currently uncommon in ambulatory palliative care.

Purpose of the Study:

  • To implement and evaluate a fellow-driven quality improvement initiative for operationalized depression screening.
  • To assess the feasibility and acceptability of the Patient Health Questionnaire-2 (PHQ-2) for depression screening among palliative care clinicians.

Main Methods:

  • A clinic-wide implementation of the PHQ-2 was conducted, supported by electronic medical record (EMR) templates, clinician training, and referral resources.
  • The primary outcome measure was the rate of EMR-documented depression screening.
  • Secondary measures included clinician-reported perspectives on the feasibility and acceptability of the PHQ-2.

Main Results:

  • Operationalized depression screening rates increased from 2% to 38% post-implementation.
  • All participating clinicians reported that incorporating depression screening was both useful and feasible within their workflow.
  • The intervention demonstrated a substantial improvement in depression screening rates.

Conclusions:

  • Operationalized depression screening is feasible within ambulatory palliative care workflows.
  • Strategies such as pre-visit screening completion may further enhance screening uptake and effectiveness.
  • This initiative highlights a successful model for integrating mental health screening into palliative care.