EP1020 - An implementation science approach to improving the uptake of depression treatment in cancer patients: iCan DepCare

Purpose/Background: Depression is associated with cancer recurrence, diminished quality of life (QoL), increased healthcare expenditures, chemotherapy nonadherence, and racial and ethnic disparities in cancer outcomes. A systematic review and meta-analysis showed that patients with colorectal cancer have poorer survival and worse quality of life by nearly 15% and 15 points on scale, respectively. Few if any strategies have been developed to improve uptake in medical and surgical oncology settings.

Methods/Interventions: We conducted a scoping review of qualitative facilitators and barriers to depression screening and treatment in oncology settings followed by patient and provider interviews and focus group sessions which were thematically analyzed and coded using the Consolidated Framework for Implementation Research. We then used a novel implementation mapping framework, and the Behavior Change Wheel (BCW) to design a behavior theory-informed strategy that would target barriers at multiple levels. We focused on our analyses on the colorectal cancer subgroups.

Results/Outcomes: Key barriers reviewed by our qualitative analysis included stigma, unclear provider roles as barriers, poor patient-provider relationships, difficulties navigating the healthcare system, and a lack of resources offered by clinics, inconsistent screening, limited outside referrals, absence of systemized CC, time constraints, staffing limitations, and gaps in patient understanding of available resources. Leadership support, electronic health record prompts, peer support, personal relationships with providers, embedded psycho-oncology teams, early conversations about depression in cancer care plans, patient-friendly resources, and personalized interventions emerged as facilitators. We mapped barriers to key behavior change techniques/strategies including education, capacity building, clinical data relay, and patient activation. Leveraging user centered design principles, we developed an EHR integrated psychoeducation-activation prototype that delivers personalized treatment recommendations, resources and stress relief. The final strategy (iCan DepCare) for promoting depression care includes ongoing technical assistance for clinic champions/staff, triage support, education, reminders for oncology teams, and the digital psychoeducation tool for patients.

Conclusion/Discussion: We applied behavioral and implementation methods, combined with contextual data analysis, to develop a multilevel implementation strategy to increase uptake of screening and treatment for depression in medical and surgical oncology settings. This study and its implementation design represent a new approach to depression care in oncology, targeting a condition that profoundly affects cancer and surgical outcomes.