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