Clinical depression identified as a significant problem among palliative care patients

Research indicates 25% of patients meet criteria for major depression

Studies suggest that depression is under-detected and under-treated in this group

Less than 50% are treated leading to decreased quality of care

A number of issues unique to the palliative care setting act as barriers to providing care

Reluctance of patients to discuss emotion Care staff primarily focus on physical care Care staff have poor knowledge of

depression and lack experience in recognising depression

Lack of standardised procedures for assessing and addressing mental health problems

Few previous studies on training programs for depression for palliative care staff

Not comprehensive Small sample sizes Limited outcome measures No control groups

Development and evaluation of a depression training program for palliative care staff

• Increases staff members knowledge, attitudes and self-efficacy in working with depressed patients, and reduces the perceived barriers

• Improves early detection and monitoring of depressive symptoms. Increases referral rates

• Enhances psychological support provided to patients and their family members

Conduct a needs analysis with palliative care staff/managers, patients’ family members

Develop a four-session training program for palliative care staff

Deliver and evaluate program for effectiveness in a controlled trial

- 2 intervention groups (1 metro and 1 rural)

- 1 control group

Interviews with 8 managerial staff 10 non-managerial staff 10 family members of patients in care

• Limited knowledge regarding clinical features

• Difficulties differentiating symptoms• Focus on physical symptoms• Low self-efficacy to provide support• Need for appropriate screening instruments• Lack of collaboration between palliative

care staff and family members• Psychosocial needs of family not being met

Session 1: Understanding depression

Session 2: Detecting depression

Session 3: Responding to depression

Session 4: Family focus

Staff Knowledge of depression (30 items) Attitudes towards depression and caring for

depressed patients and family (21 items) Self-efficacy in detecting and working with

depressed patients and family (16 items) Perceived barriers to the provision of care (12 items)

Effectiveness ascertained by number of patient referrals made for depression

- Three months pre-training compared to - Three months post-training Post-training interviews with patient family

members assessing perceptions of care provision

ParticipantsMetro Regiona

lControl Total

N 24 35 31 90

Nurses 16 22 25 63

Allied Health 8 13 6 27

Previous training in depression

17% 51% 42% 39%

Years working in palliative care

5.3 10.4 7.5 8.0

Years of formal training

2.9 4.6 3.9 3.8

Staff self-report questionnaires – there was a significant increase in staff knowledge, attitudes and self-efficacy in working with depression and a reduction in perceived barriers to care when working with depression, among staff completing the program compared to the control group

Depression referral rate data – number of referrals increased significantly between the pre-training and post-training at both EH (49%) and SWH (47.1%) sites. This suggest that the skills in detecting and responding in an appropriate way improved after completing the training program

Post-training interviews with family members

- Data collected through interviews with faamily members suggest that few, if any, observable changes occurred in staff practices from pre-training.

Note: 1. Accurate picture of such changes was difficult to gauge.

2. Family members were reflecting on all staff.

Patient outcome measures – no direct measures

Family member interviews – difficult to note changes regarding staff

Staff retention at T3 – staff attrition due to staffing and management changes

Attitudinal changes in staff - not maintained

Patient outcome measures to be developed Refresher courses for sustainability of

improvements Re-structured 2 session course appears to

be more acceptable and has the potential to produce similar positive outcome.

Palliative care staff identify the need for , and benefit from depression training

Training is effective in improving staff knowledge, self-efficacy in providing care, decreasing perceived barriers to care provision and increasing referrals

Training is an appropriate mechanism to improve detection and care provision

Professor Marita McCabe-Deakin University Professor David Mellor - Deakin University Dr. Tanya Davison – Deakin University Professor Kuruvilla George – Eastern Health Mr. Shane Storer – SW Healthcare Dr. Juli Moran – Eastern Health Dr. Eric Fairbank – SW Healthcare Mr. David Hallford – Deakin University Dr. Denisa Goldhammer – Deakin University