Innovative models of shared care
Collaborative care refers to an approach in which a multidisciplinary team of healthcare professionals provide patient care in a co-ordinated fashion. MPCCC’s collaborative care project is about harnessing the expertise of qualified health professionals in the community to support hospital providers in delivering best practice cancer care.
A pilot for cancer-related depression
Clinical depression is poorly recognised and treated in patients with cancer. International studies have determined that around 73% of cases go undetected, resulting in significant distress and reduced quality of life for patients.
This data, together with a shortage of hospital-based psychiatrists and psycho-oncologists in MPCCC partner health services highlighted a need to improve patient access to supportive care. MPCCC responded by piloting a collaborative care modle for patients with cancer related depression.
Through implementing the pilot for patients with cancer related depression, MPCCC was able to evaluate whether the collaborative care approach was clinically effective, acceptable to patients and healthcare providers, and administratively achievable.
Pilot study participants
MPCCC’s collaborative-care pilot for cancer related depression involved a team of:
- expert hospital-based oncologists and psycho-oncologists form Cabrini, Monash Health and Peninsula Health
- specialty-trained community-based psychologists
- General Practitioners
- cancer patients who had been diagnosed with clinical depression.
- co-ordinating staff to manage interactions across the team
- a steering committee to provide advice and oversee the project
Outcome
The pilot was evaluated by independent expert researchers, including a quantitative evaluation conducted by Dr Irene Bobovski, Research Fellow, Department of Psychiatry, Monash University; and a qualitative evaluation conducted by Associate Professor Clare O’Callaghan, Senior Research Associate, Palliative Care, Cabrini Health.
The quantitative evaluation found that a majority of participating patients experienced a clinically significant improvement to their depression, with 78.6% recording a 5-point reduction on the Patient Health Questionnaire at 12 weeks post-treatment. This translated to quality of life improvements related to relationships, self-worth, pain and emotional wellbeing.
The qualitative evaluation, which took the form of interviews with a representative selection of participants and patients, found the model to be highly effective.
“This collaborative care pilot upskilled psychologists, which ultimately helped cancer care teams to provide their patients with more holistic care,” said one participant in the pilot.
The pilot model was found to be acceptable to patients, measured through satisfaction with the therapy experience, development of a bond between patient and therapist, and the patient’s sense that their psychological care was being delivered in a professional, evidence-based way.
Participating health practitioners reported an increased understanding and empathy for cancer patients with existential and biopsychosocial issues.
“I now feel more confident in working with people affected by cancer beyond the life of this project,” one clinical participant reported.
Group supervision sessions encouraged psychologists to learn from one another and build relationships with cancer health workers. Oncologists felt they were better able to support their patients by having referral pathways to trained community psychologists. General Practitioners found that input from referring oncologists helped patients to accept prescriptions for anti-depressants when needed.
The robustness of the model was lesser for patients who needed more sessions than the program offered; were very ill and regularly altered session times; had non-cancer focused concerns; or had cancer-focussed concerns not covered by the program.