Outpatient Depression Screening for Patients with Melanoma

BACKGROUND: Approximately 33% of people diagnosed with melanoma report high levels of psychological distress, with depression being a common problem. Depression can occur before, during, or after cancer treatment.

LOCAL PROBLEM: A local cancer institute identified depression as a problem in their adult patients with melanoma, but no formal screening occurred. The project's purpose was to increase the identification of depression risk in patients with melanoma. The project aims were to educate patients and providers on depression and to educate outpatient medical assistants on the use of an evidence-based depression screening tool.

METHODS: The Evidence-Based Practice Improvement (EBPI) was used as the project framework. One plan-do-study-act (PDSA) cycle was completed to assess project progress; no changes were indicated. The Patient Health Questionnaire-9 (PHQ-9) was selected for depression screening. This tool indicates the level of depression risk. A score of 10 or higher, which would indicate moderate depression risk, was considered positive for this project.

INTERVENTIONS: Staff were educated on implementing the PHQ-9 depression screening tool. Patients completed the institution's initial distress screening tool at their first postoperative appointment. Patients with a positive score (score of >4) were screened for depression using the PHQ-9. If a patient scored ten or greater on the PHQ-9, social work was contacted to provide follow-up information on resources.

RESULTS: Thirty-six postoperative patients completed the distress screening tool. Of these, 33% (n=12) scored a four or higher, prompting implementation of the PHQ-9. Three patients (30%) had a PHQ-9 score of 10 or higher, prompting a referral to social work.

CONCLUSION: Implementation of a formal depression screening increased the identification of symptoms, leading to early referral. For sustainability, the PHQ-9 could be attached to the distress screening form for postoperative appointment patients, allowing the patient to complete the form in the waiting room before the appointment.