Key result
None of the 8 identified studies adhered to the true definition of collaborative care, as interventions were primarily hospital-based multi-disciplinary models with limited active involvement of primary care physicians in medication prescribing and management.
Why the study?
Do collaborative care interventions for depression in adult cancer patients achieve shared care between primary care and hospital physicians?
Systematic Review (n=2,250)
Do collaborative care interventions for depression in adult cancer patients achieve shared care between primary care and hospital physicians?
Current models of depression management in cancer care reflect hospital-based multi-disciplinary care rather than true collaborative shared care involving primary care physicians.
Current cancer depression models lack true primary care integration; challenges collaborative care evidence base and requires redesigned trials with shared prescribing.
BACKGROUND: Collaborative care involves active engagement of primary care and hospital physicians in shared care of patients beyond usual discharge summaries. This enhances community-based care and reduces dependence on specialists and hospitals. The model, successfully implemented in chronic care management, may have utility for treatment of depression in cancer. The aim of this systematic review was to identify components, delivery and roles and responsibilities within collaborative interventions for depression in the context of cancer. METHODS: Medline, PsycINFO, CINAHL, Embase, Cochrane Library and Central Register for Controlled Trials databases were searched to identify studies of randomised controlled trials comparing a treatment intervention that met the definition of collaborative model of depression care with usual care or other control condition. Studies of adult cancer patients with major depression or a non-bipolar depressive disorder published in English between 2005 and January 2018 were included. Cochrane checklist for risk of bias was completed (Study Prospero registration: CRD42018086515). RESULTS: Of 8 studies identified, none adhered to the definition of 'collaborative care'. Interventions delivered were multi-disciplinary, with care co-ordinated by nurses (n = 5) or social workers (n = 2) under the direction of psychiatrists (n = 7). Care was primarily delivered in cancer centres (n = 5). Care co-ordinators advised primary care physicians (GPs) of medication changes (n = 3) but few studies (n = 2) actively involved GPs in medication prescribing and management. CONCLUSIONS: This review highlighted joint participation of GPs and specialist care physicians in collaborative care depression management is promoted but not achieved in cancer care. Current models reflect hospital-based multi-disciplinary models of care. PROTOCOL REGISTRATION: The protocol for this systematic review has been registered with PROSPERO. The registration number is CRD42018086515.
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Shaw et al. (2019) conducted a systematic review in Depression in adult cancer patients (n=2,250). Collaborative care (shared care) interventions vs. Usual care or other control condition was evaluated on Fidelity of the depression collaborative care models to recommended collaborative care criteria (components, delivery, and role responsibilities). None of the 8 identified studies adhered to the true definition of collaborative care, as interventions were primarily hospital-based multi-disciplinary models with limited active involvement of primary care physicians in medication prescribing and management.
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