Interactive Telephone System to Identify and Treat Depression
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The University of Texas M.D. Anderson Cancer Center
Houston-Harris County
Depression
Oncology clinic of a university affiliated community hospital
African Americans, Latinos |
PROJECT
Patients receive depression assessment telephone calls from an automated system, which notifies the care team when symptoms reach a designated threshold.
Cancer patients receive computer-generated calls on a twice-weekly basis for four months. The interactive voice system first identifies a patient, and then presents a series of questions that serve to assess and monitor the patient’s depressive symptoms. Patients are asked to report on their levels of sadness, distress, and other cancer-related symptoms, via the touch-tone buttons of their phone. In addition to regularly monitoring patients’ depression symptoms, the system also alerts providers when a patient’s reported level of distress reaches a designated threshold. When a patient’s mood rating reaches the threshold, a notice is forwarded by page or email to the psychiatric advanced-practice nurse, and prompts providers to follow clinical-practice guidelines in response to reported symptoms. In addition, the patient’s mood ratings are summarized and placed in a report that is emailed to the psychiatric nurse and attending oncologist prior to the patient’s next clinic visit.
RATIONALE
Cancer patients develop clinical depression at rates far in excess of those in the overall population. Depression is a significant source of impaired physical and social functioning, and may lead those patients to postpone or cease potentially life-saving therapies. However, due to a variety of factors, depression is often under-diagnosed and under-treated in this
patient population.
By incorporating an automated and standardized screening and monitoring protocol into existing clinical infrastructure, this intervention aims to increase the identification of depression symptoms in African American and Latino cancer patients, and improve the care they receive.
EVALUATION PLAN
Funded by Finding Answers in 2008.
Researchers are conducting a randomized controlled clinical trial to determine if the intervention leads to improved identification and treatment of depression. Low-income African American or Latino cancer patients are being recruited and randomized into either the intervention arm or the control-group arm of the study. Patients randomized into the intervention group are receiving twice-weekly automated assessment calls, which are shared with the provider on a regular basis, or immediately if mood ratings reach a defined threshold. Control-group patients are receiving treatment as usual. Researchers are comparing the two groups to determine whether patients’ clinical outcomes improved, as determined by the severity of their depression symptoms, their quality-of-life indicators, and measurement of their functional status. Researchers are also gathering feedback about the intervention from both providers and patients to inform further development. The costs of the intervention are being examined in order to evaluate the feasibility of maintaining the intervention at the evaluation site and the possibility of expanding it to other hospital or clinic settings.
Principal Investigators:
- Karen O. Anderson, PhD, MPH
- Guadalupe Palos, RN, LMSW, DrPH
For More Information
Please Contact:
Karen O. Anderson, PhD, MPH
koanderso@mdanderson.org
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