Rates of depression are so high among the general population that among the dying, screening for it should simply become a routine part of a checkup. Psychiatrist Harvey Chochinov recommends that doctors just ask patients: “Are you feeling depressed?” In studies he conducted with 197 patients receiving palliative care for advanced cancer, this single-item interview was as valid as other brief screening tools, such as the Beck Depression Inventory Short Form (Chochinov et al., 1997). Simply asking this question can begin an important conversation with patients.
An organization might decide to try improving depression screening rates for oncology patients or could begin with an even more specific group of patients - say, by screening all breast cancer patients for the next month. Chances are, anywhere from 10 to 20 percent of these patients will be depressed. The team could record how many patients are depressed, the treatment modalities tried, and their outcomes.
Teams can begin by:
How to manage such an endeavor? A team could aim to screen 5 or 10 patients each week for depression and could decide that within the following month, at least 90 percent of those who are depressed would be referred for treatment. Once broad screening measures are under way and the team has established a target level for follow-up, it can begin to measure outcomes. For instance, depressed patients could be scheduled for follow-up within one week of their initial visit. Follow-up for those who receive treatment can occur within another period of time - say, six to eight weeks.
Depression screening can be an early intervention, when patients are first diagnosed with a terminal illness. Screening can also become a routine part of the treatment plan. Rather than assume that a patient is depressed because he or she is dying, and consequently needs no treatment providers should assume that the patient is depressed and has a terminal illness - and that at least the depression can be treated.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].