The University of Texas M.D. Anderson Cancer Center
Houston-Harris County
Depression
African American, Latino

Project

Patients receive depression assessment telephone calls from an automated system, which notifies the care team when symptoms reach a designated threshold.

Cancer patients receive computer-generated calls on a twice-weekly basis for four months. The interactive voice system first identifies a patient, and then presents a series of questions that serve to assess and monitor the patient’s depressive symptoms. Patients are asked to report on their levels of sadness, distress, and other cancer-related symptoms, via the touch-tone buttons of their phone. In addition to regularly monitoring patients’ depression symptoms, the system also alerts providers when a patient’s reported level of distress reaches a designated threshold. When a patient’s mood rating reaches the threshold, a notice is forwarded by page or email to the psychiatric advanced-practice nurse, and prompts providers to follow clinical-practice guidelines in response to reported symptoms. In addition, the patient’s mood ratings are summarized and placed in a report that is emailed to the psychiatric nurse and attending oncologist prior to the patient’s next clinic visit.

Rationale

Cancer patients develop clinical depression at rates far in excess of those in the overall population. Depression is a significant source of impaired physical and social functioning, and may lead those patients to postpone or cease potentially life-saving therapies. However, due to a variety of factors, depression is often under-diagnosed and under-treated in this
patient population.

By incorporating an automated and standardized screening and monitoring protocol into existing clinical infrastructure, this intervention aims to increase the identification of depression symptoms in African American and Latino cancer patients, and improve the care they receive.

Summary Results

Automated, interactive depression assessment telephone calls were successful at predicting the presence of depression in cancer patients and provided psychiatrists and psychiatric nurses with automatic updates on the severity of depressive symptoms in patients. Depression scores improved in the intervention group by an average of 2.18 points in BDI-II scores, but with no significant difference from the control group receiving usual care which decreased by 1.98 points. This is a feasible intervention.

Publications

Automated Pain Intervention for Underserved Minority Women with Breast Cancer
Cancer. 2015;121(11):1882-90. Published online 2015 Feb 24.
Full Article (subscription may be required)

Principal Investigators

• Karen O. Anderson, PhD, MPH
• Guadalupe Palos, RN, LMSW, DrPH