Background
Methods
Study eligibility
Types of studies
Participants
Interventions
Controls
Outcomes
Search strategy
Data abstraction
Results
Study characteristics
Author, Year Country | Study Design and comparator group(s) | Study Aims | Primary outcome | Sample Size and % females | Mean Age (SD) | Cancer Type | Depression | Setting | Collaborative care protocol |
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Dwight-Johnson [35] (2005) USA | Randomised pilot study comparing collaborative care intervention with usual care | Determine whether primary care collaborative depression be adapted and implemented in public sector oncology clinics serving low-income Latino patients | ≥50% improvement in depression score (PHQ9) at 8 months | 55 (100% female) | 47.2 (11.3) | Breast or cervical, mixed stage | MDD dysthymia or had persistent depressive symptoms at baseline & 1 month | Cancer centre | IMPACT |
Strong [36] (2008), Scotland | Single centre proof of concept RCT comparing collaborative care intervention with usual care | Investigate whether usual care plus depression care for people with cancer (intervention) could achieve a greater reduction in depressive symptoms at 3 months compared to usual care alone, and whether this would be sustained at 6 and 12 months. (SMART1) | self-reported depressive symptoms (SCL-20D) at 3 months | 200 (71% female) | 56.6 (11.8) | Heterogeneous stage not reported | MDD | Cancer care centre | Depression Care for People with Cancer |
Ell [37] (2008; 2011) USA | Single centre efficacy RCT comparing collaborative care intervention with Enhanced usual care (standard oncology care plus psycho-educational pamphlets; list of center/community financial, social services, transportation, and childcare resources) | Determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia | Treatment response at 12 months; defined as 50% or a 5-point reduction of PHQ-9 score | 472 (85% female) | TBC | Heterogeneous stage mixed | MDD or dysthymia | Cancer centre | IMPACT |
Fann [38] (2009 USA) | Multicentre RCT comparing collaborative care intervention with usual care | Examine the effectiveness of collaborative care (IMPACT) for depression in in older primary care patients | treatment response defined ≥50% reduction in SCL-20 score at 12 months | 215 (60% female) | 71.75 (0.5) | Mixed type and stage | MDD or dysthymia | Primary Care | IMPACT |
Kroenke [39] (2010) USA | RCT comparing collaborative care intervention with usual care | To determine whether centralized telephone-based care management coupled with automated symptom monitoring can improve depression and pain in patients with cancer. | Reduction of ≥50% in depression severity; (HSCL-20) at 12 months. | 405 (309 depression; 68% female) | 58.8 (10.8) | Mixed type and stage | depressed mood, anhedonia; or both. Moderately severe based on PHQ9 | Telephone | Study specific |
Sharpe [40] (2014) Scotland | multicentre effectiveness and cost effectiveness RCT comparing collaborative care intervention with usual care | Establish whether depression care for people with cancer (intervention) is better than usual care in achieving a clinically useful improvement in depression (SMART 2) | ‘treatment response’ measured at 24 weeks; defined as a reduction of ≥50% baseline depression score, measured via Symptom Checklist (SCL-20D) | 500 (90% female) | 56.3 (10.1) | Breast, gynaecological, genitourinary; ‘good prognosis’ | MDD | Cancer care centre or primary care clinic | Depression Care for People with Cancer |
Walker [33] (2014) Scotland | Multicentre efficacy RCT comparing collaborative care intervention with usual care | Assess the efficacy of an integrated treatment programme (depression care for people with cancer) for major depression in patients with lung cancer compared with usual care. (SMART 3) | average depression severity during trial participation: participant’s depression severity averaged over the time from randomisation up to a maximum of 32 weeks | 142 (65% female) | 63.7 (8.8) | Lung; ‘poor prognosis’ | MDD | Patient’s home or cancer centre/hospice | Depression Care for People with Cancer |
Steel [34] (2016) USA | Multicentre efficacy RCT comparing collaborative care intervention Enhanced usual care (usual care + if a patient scored high on the CES-D care coordinator provided education about the symptoms and referrals to a mental health professional/ GP) | Examine the efficacy of a collaborative care intervention in reducing depression, pain, and fatigue and improve quality of life | Reduction in depression (CES-D) at 6 months | 261 (82 depression; 27% female) | 61 (11) | Upper GI cancer or other primary cancers with liver mets | No specific eligibility criteria for depression; subgroup analysis of patients with CES-D > 16 at baseline | Telephone and oncology outpatient clinic | Study specific |
Collaborative care interventions
Study setting
Model components
Study | Treatment Initiation/Psychoeducation | Treatment Planning | Psychological Treatment | Antidepressant Management (AM) | Treatment phase | Maintenance phase | Treatment Review | Maintenance Review | Follow Up |
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Dwight-Johnson [35] (2005) | Education session delivered by Cancer/Depression Clinical Specialist (social worker) included: importance of depression treatment to cancer treatment adherence, overall health and wellbeing; education about anti-depressants and problem-solving therapy | Patients choose either anti-depressant or problem-solving therapy as first line therapy. Treatment plan was recorded in the medical record | Problem-solving intervention weekly sessions with the social worker | initial meeting with patient, oncologist and SW to initiate treatment. Psychiatrist was available for same day consultation as required. Oncologist provided medication follow up during regularly scheduled clinic visits | 8 weeks/sessions | 8 months | 2 weeks | Regular oncology clinic visits | SW follow up every 2 weeks – side effects, medication adherence, depression symptoms for 8 weeks SW provides feedback to oncologist and psychiatrist Patients who did not experience 50% reduction in symptoms after 8 weeks were scheduled for a consultation with psychiatrist to make treatment adjustments Results of consultation were feedback to oncologist and SW. Medication follow up conducted by psychiatrist or oncologist |
Fann [38] (2009) | Depression Care Manager (DCM - a nurse or clinical psychologist) conducted a psychosocial history, provided education and behavioural activation | Patients offered depression management by a depression care manager working collaboratively with the patient and primary care physician in the patient’s usual primary care clinic Patients identify treatment preferences | Structured six- to eight-session psychotherapy program: Problem-Solving Treatment (PST), behavioural activation in Primary Care delivered by the DCM | Prescribed by the patients’ primary care clinician based on a stepped-care pharmacotherapy algorithm recommending routinely available antidepressant medications | Upto 10 (45 min) structured sessions over 3 months | 3 months | In line with session schedule | Monthly PHQ9 | In person or telephone follow-up every 2 weeks during acute-phase treatment, with subsequent monthly contact during continuation and maintenance phases |
Ell [37] (2008) | The initial cancer depression clinical specialists (CDCS; bilingual social workers) conduct a semi structured psychiatric/psychosocial assessment; patient depression, psychotherapy, and antidepressant education; consideration of initial treatment choice; and provision of patient navigation assistance and included family members at patient request. | A personalized treatment plan that included patient AM or problem-solving therapy (PST) preferences. After acute treatment, patients received a treatment maintenance and relapse prevention program, including CDCS monthly telephone contacts up to 12 months after treatment | CDCS provided Problem Solving Therapy; Weekly sessions ranging from 6 to 12 weeks. Community services navigation was also provided | Psychiatrist prescribed | 6–12 weeks | 12 months | Not specified | monthly | CDCS telephone maintenance/relapse prevention and outcomes monitoring over 12 months. |
Strong [36] (2008) | Patients screened in outpatient cancer clinics to identify MDD | Patient’s primary-care doctor and oncologist informed of the diagnosis and provided with advice on choice of antidepressant drug if requested. | Nurse-delivered a maximum of 10 one-to-one sessions over 3 months. The content of the intervention comprised education about depression and its treatment, problem-solving treatment (PST) | Primary-care doctors prescribed AMs. If the patient decided, during discussions with the nurse, to start or change AM, they were encouraged to contact their primary care doctor for this purpose. GP contacted by the nurse (by fax or telephone) to provide information about the patient and advice from a study psychiatrist. | Stepped care model: Step 1–10-12 weeks Step 2: a further 10 weeks Step 3: psychiatric referral | 12 months | Weekly or bi-weekly | monthly | For 3 months after the treatment sessions progress was monitored by monthly telephone calls |
Sharpe [40] (2014) | Nurses establish a therapeutic relationship with the patients, provide information about depression and its treatment, | Psychiatrists supervise treatment. They advise primary care physicians about AM prescribing and provide direct consultations to patients who are not improving. | Nurse delivered brief evidence-based psychological interventions (problem-solving therapy and behavioural activation) and monitor patients progress | If the patient chooses to try medication, the care manager liaises with their GP regarding a prescription. The supervising psychiatrist may make a recommendation to the GP regarding the choice of medication, based on the profile of the patients’ depressive symptoms, potential side effects and possible interactions with other drugs. | 3 telephone calls over 12 weeks | 12 months | Automated monitoring: twice a week for the first 3 weeks, then weekly during weeks 4 through 11 | twice a month during months 3 through 6, and once a month during months 7 through 12 | |
Walker [33] (2014) | The depression care for people with lung cancer treatment programme is adapted to include strategies to achieve a rapid treatment response and to enable the patient to continue treatment despite physical deterioration. Nurses establish a therapeutic relationship with the patients, provide information about depression and its treatment and monitor patients’ progress | Psychiatrists supervise treatment, and provide direct consultations to patients who are not progressing | Nurses deliver brief evidence-based psychological interventions (problem-solving therapy and behavioural activation) in 10 structured sessions over 4 months in the persons home. | Psychiatrists supervise treatment, advise primary care physicians about prescribing to ensure rapid initiation and proactive adjustment of antidepressants, and provide direct consultations to patients who are not progressing | Upto 10 sessions over 4 months | 8 months | In line with session schedule | Monthly Automated PHQ9 | The nurse monitors the patient’s PHQ-9 scores monthly by telephone for a further 4 months and provides additional sessions for patients who do not meet treatment targets |
Kroenke [39] (2010) | Participants undergo automated symptom monitoring by either telephone or the Internet, depending on their preferences. Participants can receive scheduled (automated) calls from the system (outbound), can initiate calls themselves to the system if these are more convenient (inbound) or, if they have a personal computer, can enter a secure Web site to complete their surveys. All participants receive an initial call (Week 0) to assess symptom severity and initiate treatment and a follow-up call in 1–2 weeks to assess symptom severity, adherence and adverse effects. Participants with depression receive two additional DPCM follow-up calls in the first 12 weeks of treatment | the nurse care manager recommends treatment for symptoms in accordance with evidence-based guidelines and monitors response and adherence | Telephonic care management was delivered by a nurse care manager trained in assessing symptom response and medication adherence; in providing pain and depression specific education; and in making treatment adjustments according to evidence-based guidelines | The oncologist implements treatment recommendations based on antidepressant algorithms. Treatment recommendations were provided to the study participant’s oncologist who was responsible for prescribing all medications and the psychiatrist becomes directly involved in the management of difficult cases | Upto 10 30-45 min sessions in 16 weeks | 4 months | In line with session schedule | Monthly PHQ9 | Participants received a baseline and 3 follow-up calls (1, 4, and 12 weeks) during the first 3 months of treatment. In addition to these scheduled telephone contacts, triggered telephone calls occurred when automated monitoring indicated inadequate symptom improvement, nonadherence to medication |
Steel [34] (2016) | The medical team referred each patient and a psychiatric intake conducted by the care coordinator (psychologist) The web-based collaborative care intervention included access to a psychoeducational web site and to a collaborative care coordinator. The website included (1) psycho-educational information with regard to depression, pain, fatigue, nausea and vomiting and sleep; (2) a self-management area where the patient could record their symptoms and monitor changes through graphical depictions; (3) an area for journaling; (4) a chat room that connected the patient to other patients enrolled in the study, (5) an audiovisual library that included relaxation techniques and educational videos by the patient’s nurse coordinators; and (6) resource library. | The patient had telephone contact with the care coordinator approximately every 2 weeks and face-to-face contact with the care coordinator in the oncology outpatient clinic and/or hospital approximately every 2 months. | The care coordinator provides CBT and/or recommendations for pharmacological management of symptoms if the patient preferred medication to CBT or in addition to CBT. | The care coordinators provided information to the medical team about any changes in a patient’s symptoms that might have warranted changes in treatment. The care coordinator would discuss with the patient if s/he was interested in changing their treatment. The medical team may or may not have accepted the care coordinators’ recommendations | 2 weekly telephone and monthly face to face | 6 months | Not stated | Not stated | The care coordinators would have face-to-face contact with each patient in the outpatient cancer clinic or in the hospital when the patient visited the hospital for follow-up or treatment. The care coordinators contacted patients by phone but were also available as needed to the patients for questions and concerns. |
Inter-professional roles within the collaborative care model
Authors (year) | Care Co-ordinator | General Practitioner | Oncologist | Psychiatrist | Interdisciplinary Communication | Intervention Training | Fidelity Assessment |
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Dwight-Johnson [35] (2005) | Social workers (CDCS) carry out the majority of treatment: problem solving treatment (PST); patient navigation/case management; monitoring, follow up. | No role | antidepressant prescribing | Advice to oncologist; medication follow up; bi-weekly supervision to CDCS. | CDCS provides feedback to oncologist and psychiatrist. | Oncologist provided with two 1-h education sessions by psychiatrist on depression. Given summarised pocket reference guides. | Not reported |
Strong [34] (2008) | Nurse - psychoeducation & PST, patient monitoring, communication, liaison between patient, psychiatrist &GP | Antidepressant Prescribing | No role defined | Supervise treatment; Review non-responders; prescribing advisory role. Weekly nurse supervision. | Nurse contacted GP for medication initiation / change and advice from the psychiatrist | Nurse: written materials, tutorials and supervised practice over 3 months. | All nurse sessions video recorded; 10% assessed for adherence |
Ell [37] (2008) | Social workers (CDCS) carry out the majority of treatment: PST; communication with the oncology; translators during psychiatric evaluations; patient navigation/case management.. Note: patients choose first line therapy | No role | Monitoring antidepressants in consultation with psychiatrist in maintenance phase | Supervise treatment, prescribe antidepressants. Weekly CDCS supervision | CDCS interacts via written notes or verbally with the treating oncologist; CDCS and psychiatrist manage patients via a clinical data tracking secure website and weekly telephone supervision sessions | Structured training in PST and the study algorithms | Quality assurance by an independent ‘expert’ on 5 audiotaped SW sessions. |
Fann [38] (2009) | DCM (nurse or Clin psych) conduct psychosocial history, provide education and behavioral activation; identify treatment preferences: antidepressants and a structured six- to eight-session PST | Make treatment choices | No role | Encouraged to see patients who presented diagnostic challenges/persistent depression for in-person consultations in the primary care setting. | DCM met weekly with a supervising psychiatrist & primary care physician (PCP) to monitor clinical progress/adjust treatment plans | Not reported | Not reported |
Kroenke [39] (2010) | DPCM (nurse) recommends treatment in accordance with evidence-based guidelines; monitors response/adherence. | Nil | detects bothersome symptoms; implements treatment recommendation | Supervises DPCM; advises on complex/nonresponding cases | DPCM met weekly to review cases with the pain-psychiatrist to discuss management issues Contact with oncology not specified | Not reported (though notes that the nurse was trained) | Not reported |
Sharpe [40] (2014) | Nurse: psychoeducation &PST, behavioural activation; patient monitoring, communication, liaison patient, psychiatrist &GP | Antidepressant Prescribing | No specific role | Supervise treatment; Review non-responders; prescribing advisory role. Weekly nurse supervision | DCPC states: Regular reports are sent to the GP (with copies to other relevant professionals) which detail the patient’s current antidepressant medication, depression score and progress in treatment. The reports are checked by a supervising psychiatrist before being sent and any recommendations are added regarding changes to antidepressant medication | 2-3 month training. Achievement of competency in specific clinical areas (basic oncology, basic psychiatry, advanced communication skills, depression assessment and treatment, suicide risk assessment, problem solving therapy, use of the DCPC treatment manual). Training comprised: tutorials, directed reading, role plays and simulated patient treatment sessions. Assessments were both written and practical | Treatment sessions video-recorded. Supervising psychiatrist watched the video-recordings of each nurse’s early sessions; detailed feedback. Standardised rating sheets for each treatment session type completed by nurses and by the supervisors to determine adherence to the treatment approach. Specified behaviours and proscribed behaviours assessed. An independent researcher rated 10% of DCPC sessions. |
Walker [33] (2014) | Nurse coordinates depression care by liaising with all relevant health professionals; symptom monitoring; Provide psychoeducation & PST | Antidepressant Prescribing | Weekly review; Supervise treatment response; prescribing advisory role | Regular reports are sent to the GP (with copies to other relevant professionals) which detail the patient’s current antidepressant medication, depression score and progress in treatment. The reports are checked by a supervising psychiatrist before being sent and any recommendations are added | Achievement of competency, includes tutorials, directed reading, roleplay activities, stimulation patient sessions. | Random sample of 10% video recordings of treatment sessions, rated for adherence to treatment manual + quality of delivery | |
Steel [34] (2016) | Provision of CBT, telephone and face to face,recommendations for pharmacological management dependent on patient preferences, communication of patient preferences/change symptoms to medical team/primary physician | Primary care could manage antidepressant prescribing | Oncologist may manage antidepressant prescribing | Weekly supervision between clinical psychologists and care coordinators - to assess adherence to protocol. | The care coordinators provided information to the medical team about any changes in a patient’s symptoms that might have warranted changes in treatment, changing medication, or adding psychotherapy. However, the medical team may or may not have accepted the care coordinators’ recommendation | 300-page intervention manual- included evaluation of depression and cognitive behavioural symptoms. | Not reported |