Manuscript: Depression Screening in Oncology Hematology Clinic

Abstract

Problem & purpose: Prior to the start of this project, an oncology hematology clinic used Patient Health Questionnaire-2 (PHQ-2) to screen only a small minority of patients for depression. Three out of 180 patients (2%) were scored above 3 (positive) during the period of Jan 1st to Sep 1st, 2021. However, chart reviews showed that approximately 60% of patients had symptoms of depression at this clinic. Therefore, a low rate of depression screening existed in this clinic. The main reasons for the low rate were that the depression screening did not cover all cancer patients, and the previous process of only social worker and nurses being involved in depression screening was inadequate in this clinic. Purpose: The purpose of this Quality Improvement (QI) project was to develop a standardized process for implementing Patient Health Questionnaire-9 (PHQ-9) depression screening procedure for all new cancer patient visits at this clinic. Methods: Approximately 750 new cancer patients were expected during the 15 weeks period in this clinic. Patients completed the PHQ-9 forms under the instruction of Medical Assistants (MAs) (Figure 5). Social workers entered the data including the number of patients, the number of completed form, and the number of the PHQ-9 form scored  10 into a paper document table daily. A run chart with a line graph of the data plotted over time was used to analyze trends or patterns of the project implementation process over the 15-week project. REDCap was used for weekly data collection. Charts audit was used to check the number of screenings and referrals. Results: 755 new patients, including 680 cancer patients and 75 non-cancer patients, visited the clinic during the 15-week project period of Sep 26th, 2022, to Jan 6th, 2023. Of the approximately 47.8% (325/680) of patients who completed the PHQ-9 forms, thirty-two patients with scores ≥10. All thirty-two patients received interventions. Twenty-two patients refused to complete the PHQ-9 form. Conclusion: Findings suggest the new standard depression screening process with the PHQ-9 tool is a reliable method of screening for depression in cancer patients in an outpatient setting.