Research published by Hahn et al in JAMA showed depression screening for patients with newly diagnosed breast cancer was highly effective at identifying patients in need of behavioral health care. The new screening initiative was subsequently and successfully built into the patient care and daily workflow of medical oncology teams at Kaiser Permanente in Southern California.

“Early identification and treatment for mental health issues is critical, yet depression and other mental health issues are often underidentified and undertreated in [patients with] breast cancer,” said the study’s lead author, Erin E. Hahn, PhD, a research scientist with the Kaiser Permanente Southern California Department of Research & Evaluation. “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 … patients achieve the best possible health.”

Study Background and Methods

It has been difficult historically to incorporate mental distress screening during cancer care when patients tend to be vulnerable to mental health challenges. Researchers from Kaiser Permanente in Southern California 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 medical 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 October 1, 2017, and September 30, 2018, were included in the study. Researchers enrolled 1,436 patients: 692 in the control group and 744 in the intervention group. The groups were similar in demographic and cancer characteristics.

Study Findings

Eighty percent of patients in the intervention group completed depression screening vs 0.1% in the control group. Of intervention group screenings, 10% of patients scored in the range indicating a 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,” said Dr. Hahn. “We are incorporating the lessons learned from the trial—particularly the importance of ongoing audit and feedback of performance—and are encouraging our clinical teams to adapt the workflow to meet their needs.”

The study authors concluded, “Among patients with breast cancer treated in community-based oncology practices, tailored strategies for implementation of routine depression screening compared with an education-only control group resulted in a greater proportion of referrals to behavioral care. Further research is needed to understand the clinical benefit and cost-effectiveness of this program.”

Disclosure: This project was supported by the Regents of the University of California, Research Grants Program Office, California Breast Cancer Research Program. For full disclosures of the study authors, visit jamanetwork.com.