Kaiser Permanente in Southern California has implemented a new depression screening initiative for breast cancer patients after research showed such intervention was highly effective at identifying patients in need of behavioral health care, scientists said Tuesday.

“Early identification and treatment for mental health issues is critical, yet depression and other mental health issues are often underidentified and undertreated in breast cancer patients,” said lead author Erin Hahn, a research scientist with Kaiser Permanente Southern California. “Our study showed that the use of implementation strategies to facilitate depression screening is highly effective and provided insights into how to create a sustainable program to help our cancer patients achieve the best possible health.”

Historically, it’s proved difficult to incorporate mental distress screening during cancer care, since those patients tend to be vulnerable to mental health challenges. Kaiser Southern California researchers set out to determine if a process of incorporating depression screening into routine clinical care with support from researchers might make a difference.

They separated oncology teams at different locations into two groups. In the first group, physicians and nurses received education about depression screening, regular feedback on their performance, and support in determining the best ways to add depression screening into their current workflow.

In the second group — the control group — physicians and nurses received only education. Screening was conducted using the Patient Health Questionnaire 9-item version, known as the PHQ-9.

All patients diagnosed with new breast cancers who had a consultation with medical oncology between Oct. 1, 2017, and Sept. 30, 2018, were included in the study. Researchers enrolled 1,436 members: 692 in the control group and 744 in the intervention group. The groups were similar in demographic and cancer characteristics.

In the intervention group, 80% of patients completed depression screening versus less than 1% in the control group. Of intervention group screenings, 10% scored in the range indicating need for referral to mental health services. Of those, 94% received referrals. Of those referred, 75% completed a visit with a mental health provider.

Additionally, patients in the intervention group had significantly fewer clinic visits to the oncology departments, and no difference in outpatient visits for primary care, urgent care, and emergency department services.

“The trial of this program was so successful that, with funding from our Care Improvement Research Team, we have rolled out depression screening initiatives across all our Kaiser Permanente medical oncology departments in Southern California,” Hahn said.

The research was published Tuesday in the Journal of the American Medical Association.

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