Skip to main content

Table 2 Health Professional Roles in Collaborative Care Interventions

From: Is care really shared? A systematic review of collaborative care (shared care) interventions for adult cancer patients with depression

Study Treatment Initiation/Psychoeducation Treatment Planning Psychological Treatment Antidepressant Management (AM) Treatment phase Maintenance phase Treatment Review Maintenance Review Follow Up
Dwight-Johnson [35] (2005) Education session delivered by Cancer/Depression Clinical Specialist (social worker) included: importance of depression treatment to cancer treatment adherence, overall health and wellbeing; education about anti-depressants and problem-solving therapy Patients choose either anti-depressant or problem-solving therapy as first line therapy. Treatment plan was recorded in the medical record Problem-solving intervention weekly sessions with the social worker initial meeting with patient, oncologist and SW to initiate treatment. Psychiatrist was available for same day consultation as required.
Oncologist provided medication follow up during regularly scheduled clinic visits
8 weeks/sessions 8 months 2 weeks Regular oncology clinic visits SW follow up every 2 weeks – side effects, medication adherence, depression symptoms for 8 weeks
SW provides feedback to oncologist and psychiatrist
Patients who did not experience 50% reduction in symptoms after 8 weeks were scheduled for a consultation with psychiatrist to make treatment adjustments
Results of consultation were feedback to oncologist and SW. Medication follow up conducted by psychiatrist or oncologist
Fann [38] (2009) Depression Care Manager (DCM - a nurse or clinical psychologist) conducted a psychosocial history, provided education and behavioural activation Patients offered depression management by a depression care manager working collaboratively with the patient and primary care physician in the patient’s usual primary care clinic Patients identify treatment preferences Structured six- to eight-session psychotherapy program: Problem-Solving Treatment (PST), behavioural activation in Primary Care delivered by the DCM Prescribed by the patients’ primary care clinician based on a stepped-care pharmacotherapy algorithm recommending routinely available antidepressant medications Upto 10 (45 min) structured sessions over 3 months 3 months In line with session schedule Monthly PHQ9 In person or telephone follow-up every
2 weeks during acute-phase treatment, with subsequent monthly contact during continuation and maintenance phases
Ell [37] (2008) The initial cancer depression clinical specialists (CDCS; bilingual social workers) conduct a semi structured psychiatric/psychosocial assessment; patient depression, psychotherapy, and antidepressant education; consideration of initial treatment choice; and provision of patient navigation assistance and included family members at patient request. A personalized treatment plan that included patient AM or problem-solving therapy (PST) preferences. After acute treatment, patients received a treatment maintenance and relapse prevention program, including CDCS monthly telephone contacts up to 12 months after treatment CDCS provided Problem Solving Therapy; Weekly sessions ranging from 6 to 12 weeks. Community services navigation was also provided Psychiatrist prescribed 6–12 weeks 12 months Not specified monthly CDCS telephone maintenance/relapse prevention and outcomes monitoring over 12 months.
Strong [36] (2008) Patients screened in outpatient cancer clinics to identify MDD Patient’s primary-care doctor and oncologist informed of the diagnosis and provided with advice on choice of antidepressant drug if requested. Nurse-delivered a maximum of 10 one-to-one sessions over 3 months. The content of the intervention comprised education about depression and its treatment, problem-solving treatment (PST) Primary-care doctors prescribed AMs. If the patient decided, during discussions with the nurse, to start or change AM, they were encouraged to contact their primary care doctor for this purpose. GP contacted by the nurse (by fax or telephone) to provide information about the patient and advice from a study psychiatrist. Stepped care model:
Step 1–10-12 weeks
Step 2: a further 10 weeks
Step 3: psychiatric referral
12 months Weekly or bi-weekly monthly For 3 months after the treatment sessions progress was monitored by monthly telephone calls
Sharpe [40] (2014) Nurses establish a therapeutic relationship with the patients, provide information about depression and its treatment, Psychiatrists supervise treatment. They advise primary care physicians about AM prescribing and provide direct consultations to patients who are not improving. Nurse delivered brief evidence-based psychological interventions (problem-solving therapy and behavioural activation) and monitor patients progress If the patient chooses to try medication, the care manager liaises with their GP regarding a prescription. The supervising psychiatrist may make a recommendation to the GP regarding the choice of medication, based on the profile of the patients’ depressive symptoms, potential side effects and possible interactions with other drugs. 3 telephone calls over 12 weeks 12 months Automated monitoring: twice a week for the first 3 weeks, then weekly during weeks 4 through 11 twice a month during months 3 through 6, and once a month during months 7 through 12  
Walker [33] (2014) The depression care for people with lung cancer treatment programme is adapted to include strategies to achieve a rapid treatment response and to enable the patient to continue treatment despite physical deterioration.
Nurses establish a therapeutic relationship with the patients, provide information about depression and its treatment and monitor patients’ progress
Psychiatrists supervise treatment, and provide direct consultations to patients who are not progressing Nurses deliver brief evidence-based psychological interventions (problem-solving therapy and behavioural activation) in 10 structured sessions over 4 months in the persons home. Psychiatrists supervise treatment, advise primary care physicians about prescribing to ensure rapid initiation and proactive adjustment of antidepressants, and provide direct consultations to patients who are not progressing Upto 10 sessions over 4 months 8 months In line with session schedule Monthly
Automated
PHQ9
The nurse monitors the patient’s PHQ-9 scores monthly by telephone for a further 4 months and provides additional sessions for patients who do not meet treatment targets
Kroenke [39] (2010) Participants undergo automated symptom monitoring by either telephone or the Internet, depending on their preferences. Participants can receive scheduled (automated) calls from the system (outbound), can initiate calls themselves to the system if these are more convenient (inbound) or, if they have a personal computer, can enter a secure Web site to complete their surveys.
All participants receive an initial call (Week 0) to assess symptom severity and initiate treatment and a follow-up call in 1–2 weeks to assess symptom severity, adherence and adverse effects. Participants with depression receive two additional DPCM follow-up calls in the first 12 weeks of treatment
the nurse care manager recommends treatment for symptoms in accordance with evidence-based guidelines and monitors response and adherence Telephonic care management was delivered by a nurse care manager trained in assessing symptom response and medication adherence; in providing pain and depression specific education; and in making treatment adjustments according to evidence-based guidelines The oncologist implements treatment recommendations based on antidepressant algorithms.
Treatment recommendations were provided to the study participant’s oncologist who was responsible for prescribing all medications and the psychiatrist becomes directly involved in the management of difficult cases
Upto 10 30-45 min sessions in 16 weeks 4 months In line with session schedule Monthly
PHQ9
Participants received a baseline and 3 follow-up calls (1, 4, and 12 weeks) during the first 3 months of treatment. In addition to these scheduled telephone contacts, triggered telephone calls occurred when automated monitoring indicated inadequate symptom improvement, nonadherence to medication
Steel [34] (2016) The medical team referred each patient and a psychiatric intake conducted by the care coordinator (psychologist)
The web-based collaborative care intervention included access to a psychoeducational web site and to a collaborative care coordinator. The website included (1) psycho-educational information with regard to depression, pain, fatigue, nausea and vomiting and sleep; (2) a self-management area where the patient could record their symptoms and monitor changes through graphical depictions; (3) an area for journaling; (4) a chat room that connected the patient to other patients enrolled in the study, (5) an audiovisual library that included relaxation techniques and educational videos by the patient’s nurse coordinators; and (6) resource library.
The patient had telephone contact with the care coordinator approximately every 2 weeks and face-to-face contact with the care coordinator in the oncology outpatient clinic and/or hospital approximately every 2 months. The care coordinator provides CBT and/or recommendations for pharmacological management of symptoms if the patient preferred medication to CBT or in addition to CBT. The care coordinators provided information to the medical team about any changes in a patient’s symptoms that might have warranted changes in treatment. The care coordinator would discuss with the patient if s/he was interested in changing their treatment. The medical team may or may not have accepted the care coordinators’ recommendations 2 weekly telephone and monthly face to face 6 months Not stated Not stated The care coordinators would have face-to-face contact with each patient in the outpatient cancer clinic or in the hospital when the patient visited the hospital for follow-up or treatment. The care coordinators contacted patients by phone but were also available as needed to the patients for questions and concerns.