Implementing Mental Health Screening Assessment and Navigation (MH-SCAN) in a Community Oncology Clinic: Evaluations and Efficacy
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Significant portions of cancer patients are attempting to manage the stressors of survivorship with undiagnosed depression. Untreated depression increases mortality rates, deteriorates patients' quality of life, and disrupts adherence to cancer treatment. Despite widespread recommendations, there remains a significant gap in identification of depression and engagement in depression treatment. To fill this gap, the University of Texas Southwestern Moncrief Cancer Institute implemented Mental Health Screening, Assessment, and Navigation (MH-SCAN) as standard of care. This study evaluated factors associated with screening positive for depression, as well as the impact of Mental Health Patient Navigation on depression treatment engagement and depression symptom reduction. Universal, tablet-based screening using the Patient Health Questionnaire (PHQ-2, PHQ-9) was implemented to screen for depressive symptoms. After screening positive, a patient navigator contacted the patient to engage them in navigation services. For the current study, patients (N=500) diagnosed with cancer two years prior to PHQ-2 screening were selected for inclusion. Clinical and demographic data were collected via electronic health record review to compare patients based on positive (n=173) and negative (n=327) depression screening result. Patients who were (n=106) and were not (n=67) navigated were then compared on their engagement in depression treatment and symptom reduction. Approximately one-third of all patients screened positive for depression. Individuals, who had a pre-existing mental illness, are unmarried, have less education, are on disability, and earn USD30,000-USD40,000 per year (i.e., the "working poor") were significantly more likely to screen positive for depression. Significantly more (χ2= 62.224, p < .001) patients initiated referred depression treatment who were navigated (67%) compared to patients unable to be navigated (6%). Furthermore, patients who were navigated had significantly greater reductions in depressive symptoms (M = -6.43, SD=6.63) compared to patients unable to be navigated (M = -1.46, SD=3.87), F = 30.91, p <.001. We conclude that Mental Health Patient Navigation successfully bridges the depression screening and treatment gap, fulfilling recent recommendations put forth by numerous psychoncology groups. Our MH-SCAN program can serve as the model for future iterations of screening and treatment programs, providing crucial psychosocial care to at-risk oncology populations whose mental health has often gone underserved.