Barriers to accepting mental health care in cancer patients with depression.

This study aimed to determine barriers to accepting mental health care among depressed cancer patients. Cancer patients who screened positive for depression were referred for mental health treatment and sent a validated questionnaire designed to assess barriers to receiving mental health care. Responses were compared between patients who accepted their referral and those who did not. Among 75 patients who agreed to participate, 51 (68%) completed the questionnaire. Reported barriers to accessing mental healthcare were not significantly different between the two groups but patients residing within 50 miles of the clinic had increased odds of attending their appointment.

Correlation of sociodemographic and clinical parameters with depression and distress in patients with hematologic malignancies.

A quarter of cancer patients struggle with distress or depression during their illness. Multiple organizations including the National Comprehensive Cancer Network recommend universal screening for distress and depression. Herein, we describe a universal screening program in patients with hematologic malignancies and factors associated with distress and depression. Between December 2013 and February 2015, patients with hematologic malignancies took the Patient Health Questionnaire 9 (PHQ-9) and Distress Thermometer (DT) prior to receiving their first outpatient parenteral chemotherapy. Patient demographic information as well as information regarding visit burden and baseline use of psychiatric medications were recorded. A PHQ-9 score of ≥ 9 and a DT score ≥ 4 suggested a high risk of major depression and distress. Intergroup comparisons of categorical and continuous variables were performed via chi-square and Wilcoxon rank-sum tests. Multivariate models were constructed using the stepwise selection technique using all potential variables. Two hundred forty-six patients with a median age at diagnosis 65 years (range 18-94 years) were included. In the multivariate analysis, a PHQ-9 score ≥ 9 was associated with living alone (P = 0.007), positive PHQ-2 (P = 0.003), and high Charlson comorbidity index (CCI; P = 0.02), while a DT score ≥ 4 was associated with being married (P = 0.03) and female (P = 0.03). There was no other association with high scores on either questionnaire. Patients with hematologic malignancies often have prolonged treatment and surveillance. We identified subpopulations within this group who may be at high risk of developing distress and depression and who should be aggressively screened even when universal screening programs are not available.

Impact of advance care planning consults on advance directives completion.

OBJECTIVES: Advance care planning (ACP) consults have been credited with increasing the likelihood that patients will receive desired care at the end of life, including reduced hospitalization and spending. We aimed to investigate whether implementation of ACP consults leads to improved advance directive (AD) completion rates. STUDY DESIGN: Retrospective case-control evaluation. METHODS: Chart review was conducted among patients in hematology/oncology and primary care to compare AD completion rates of patients in each clinical area offered ACP consults between July 1, 2017, and June 30, 2018, and those not offered ACP consults prior to July 1, 2017. RESULTS: Completed ADs increased from historic rates of 1% to 65.9% of primary care patient records. Among hematology/oncology patients offered consults, completed ADs were present in 28.1% of patient records compared with historic rates of 3%. CONCLUSIONS: Patients offered ACP consults had significantly higher AD completion rates than those without consults in both primary care and hematology/oncology practices. The difference in ACP consult attendance between the primary care and hematology/oncology groups clearly suggests that further improvements can be made to assist patients in accessing AD education and completion support.