Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Building Bridges: Addressing the Barriers and Facilitators to Support Sustainable Implementation of Community-based Shared Care for Depression in Cancer (#57)

Joanne Shaw 1 , Lisa Beatty 2 , Laura Kirsten 3 , Lisa Vaccaro 1 , David Kissane 4 , Geoff Mitchell 4 , Brian Kelly 5 , Kerry Sherman 6 , Meera Agar 7 , Jane Turner 8
  1. Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Sydney, NSW, Australia
  2. College of Medicine & Public Health, , Flinders Centre for Innovation in Cancer, , Adelaide, SA, Australia
  3. 3Nepean Cancer Care Centre,, Nepean Hospital, Sydney, NSW, Australia
  4. Department of Psychiatry, Monash University, Melbourne, VIC, Australia
  5. Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
  6. Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, Australia
  7. Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
  8. Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, QLD, Australia

Aim: Prevalence estimates of major depression (16%), minor depression and dysthymia (22%) in cancer patients are higher than in the general population. Despite effective treatments, system constraints mean timely access to care is not universally being delivered to all patients. Collaborative care models have demonstrated utility in chronic disease management. A similar shared care model where GPs and community-based psychologists work with hospital-based psycho-oncology specialists, to deliver depression treatment is feasible under current Medicare funding models. The aim of this program is to identify resources and strategies to address the training needs of community-based providers and support effective inter-professional communication and shared decision-making required to facilitate successful implementation. 

Methods: Following a systematic review of the components and relative role responsibilities within collaborative depression care models trialled internationally, we used implementation science principles to inform the development of resources and communication strategies required to support a novel community-based shared care model. A barriers analysis was conducted to identify identified barriers and facilitators key for sustainable implementation.

Results: Mapping resources and strategies to the PARiHS framework’s three domains of evidence, context and facilitation resulted in the development and evaluation of the following: (1) manualized cancer-specific CBT to orientate community-based psychologists with expertise in CBT to cancer, (2) prescribing algorithms and academic detailing for GPs to facilitate evidence-based medication management, (3) oncology education modules to provide educational support, and (4) standardised mentoring and communication protocols to ensure integration of care beyond cancer services.

Conclusions: For sustainable implementation, a community-based shared care model needs to be underpinned by clear evidence-based protocols, ongoing review and access to specialised psycho-oncology support. Pilot testing of resources and ongoing engagement with local stakeholders prior to testing implementation in a pragmatic non-inferiority randomised control design, provides the opportunity to tailor resources and strategies to actual clinical practice