SCREENING FOR DEPRESSION IN POST-STEM CELL TRANSPLANT PATIENTS USING THE PATIENT HEALTH QUESTIONNAIRE (PHQ)-2 AND PHQ-9

Abstract

Problem: Clinical depression is a complication of stem cell transplantation. Depression can decrease adherence to treatment, worsen transplant outcomes, and increase mortality. At the University of Kansas Cancer Center (KUCC)’s Blood and Marrow Transplant (BMT) clinic, new patients are screened for depression using the Distress Thermometer during their first visit. This screening practice does not identify depression among patients after transplant. It was therefore important to implement standardized depression screening for post-stem cell transplant patients. Project Aims: The project aims of this quality improvement (QI) were: 1) to implement standardized screening tools (PHQ-2 and PHQ-9) for depression in this high-risk post-transplant patient population over 30 days, 2) to evaluate the effectiveness of PHQ-2 and PHQ-9 in detecting depression in post-transplant patients, and 3) to obtain feedback of the new screening process for depression from the medical assistants. Project Methods: The Plan-Do-Study-Act cycle guided this QI project. All post-stem cell transplant patients were screened for depression using PHQ-2 and if their scores were positive, they were screened with the PHQ-9. Patients screened positive on the PHQ-9 were assessed by their healthcare providers on the same day of their visits. Providers would initiate an antidepressant medication and/or refer the patient to mental health services. The following information was reported for a 30-day implementation period: the number of patients who were screened positive for depression by the PHQ-2 and PHQ-9, the number referrals to mental health services, and the number of antidepressants prescribed. Medical assistant feedback regarding the new screening process for depression were also reported. Findings: During the 30-day screening period, more than 200 post-transplant patients were screened for depression. Chart review were performed on a total of 101 randomly selected patients. Most of these patients (n = 100) were screened for depression using PHQ-2 and PHQ-9. Nine patients had a positive PHQ-2 score (≥ 3) and received additional screening of PHQ-9. Eight patients were screened positive on the PHQ-9 (≥ 5) with four patients being newly diagnosed with depression. These four patients were either referred to mental health service and/or started on antidepressants. Medical assistant (MA) survey results showed that patients were willing to answer PHQ questions to the MA and the screening process took less than 3 minutes to complete. Most MA’s expressed their willingness to continue PHQ screening. Conclusion: The new screening process for depression using PHQ-2 and PHQ-9 was effective to identify patients with depression. It was also useful for healthcare providers to reassess the treatment plans for those with existing diagnosis of depression. It is recommended that the PHQ results should be automatically shown to the healthcare provider in the best practice advisory in assessment and plan. This will help better optimize PHQ use in the BMT clinic.