Evidence-Based Clinical Issue: Depression Treatment Plan

Abstract

Modern medicine possesses a profound knowledge about various forms of cancer and has developed advanced approaches to treating the disease. However, in the majority of hospitals, such treatment is only focused on the physical aspect of cancer. It has been found by many researchers that it is common for patients to develop depressive disorder because of long-lasting treatment of terminal diseases, and that the mental state of a patient has a crucial impact on their chances for survival. Therefore, it has been decided to design a plan and procedures for detecting and preventing depressive disorders in patients diagnosed with cancer registered in the Local Community Hospital. The project aims to answer the following clinical question: in patients diagnosed with cancer, how effective is the appliance of a depression treatment plan compared to treatment provided only on a physical level in increasing their quality of life and chances for a quicker recovery during long-term treatment? The study will be implemented in form of a randomized controlled trial engaging 80 patients diagnosed with cancer. The intervention group will receive complex treatment including psychotherapy, music therapy, and antidepressants, which was proved effective by other researchers. In case of successful implementation of the project, the procedures will be integrated into the regular cancer treatment routine.

Part I. Introduction

Modern medicine possesses a profound knowledge about various forms of cancer and has developed advanced approaches to treating the disease. However, in the majority of hospitals, such treatment is only focused on the physical aspect of cancer. It has been found by many researchers that it is common for patients to develop depressive disorder because of long-lasting treatment of terminal diseases (DeJean, Giacomini, Vanstone, & Brundisini, 2013). The first signs of depression arise straight after being diagnosed with a disease and progress throughout the costly and exhausting treatment (Sullivan, Forsberg, & Slatore, 2015). The effect of emotional distress on the recovery process has been found considerably negative by researchers. Thus, Steel et al. (2016) state that the psychological well-being of a cancer patient is the major “predictor of survival” (p. 2). Therefore, it has been decided to design a plan and procedures for detecting and preventing depressive disorders in patients diagnosed with cancer who are registered in the Local Community Hospital. The team is certain that the integration of emotional health practices will significantly decline the mortality rate and improve the quality of life of the patients. The project must answer the following question:

In patients suffering from chronic diseases (P0), how effective is developing strategies to detect and prevent emotional disorders and mental illnesses (I) compared to treatment provided only on a physical level (C) in increasing patients’ quality of life and chances for a quicker recovery (O) during long-term treatment (T)?

Due to the nature of the project, no harm can be done even in case of poor outcomes. The perfect results would include a significant decrease of depression level and tumor regression. The minimum benefits for patients will be stress reduction and improvement of the general quality of life. Half of the costs are covered by the Local Cancer Fund, and the materials and all antidepressants are provided by the Mental Health Organization. The only financial responsibility of the hospital concerns honorarium for all staff members involved.

Part II. Evidence Review

While researching the issue and building the body of evidence such databases as NCBI, JURN, Science Direct, and Google Scholar were used. The search was limited to articles published in the last five years and resulted in more than 500 peer-reviewed scholarly works investigating depression treatment in cancer patients.

Okuyama, Akechi, Mackenzie, and Furukawa (2017) have studied the usage of psychotherapy in healing depressive disorder. The investigation involved a systematic review of randomized controlled trials accessed in MEDLINE, EMBASE, CINAHL, and PsycINFO (Okuyama et al., 2017). Two independent writers have screened the existing data and selected the most appropriate one to examine and compare the outcomes of psychotherapy and usual cancer treatment. Six studies and cases of seven hundred patients were analyzed. It has been revealed that the participants demonstrate better results in dealing with depression after psychotherapy.

The other study by Zhou et al. (2015) introduces music therapy and muscle relaxation treatment as an effective approach to alleviate depression and anxiety in women with breast cancer. The results displayed that the intervention group demonstrated considerably better outcomes such as lessening depression, tumor regression, and shorter hospital stay.

The project has a strong body of evidence containing two works with the first level of evidence, one article with the second level, and one study with the fourth. The evidence is focused on the effective practices for identifying depressive syndromes and presents positive outcomes of four methods of treatment in alleviating depression and anxiety. The examined cases have shown a reduction in depression symptoms and duration of hospital stay and improvement of quality of life.

Part III. Purpose of the Project

The project aims to answer the following clinical question: in patients diagnosed with cancer, how effective is the appliance of a depression treatment plan compared to treatment provided only on a physical level in increasing their quality of life and chances for a quicker recovery during long-term treatment?

The intervention is aimed to meet the emotional needs of patients diagnosed with cancer. Based on scholarly research, it has been decided to use a complex treatment consisting of psychotherapy, music therapy, and antidepressants. Psychotherapy is going to be the key element in treatment complemented by music therapy and antidepressants. Positive outcomes of previous studies regarding the same clinical issue ensure that the patients will benefit from such approach. In case of successful implementation of the project, the procedures will be integrated into regular cancer treatment routine.

In order to ensure effective and consistent realization of the project, the change theory by Lippitt will be used, containing such steps as assessment, planning, implementation, and evaluation. In addition, some aspects of the Lean Systems Approach will be considered. These two theories are popular among health workers and match the aims of the project.

Part IV. Methods

Study Design

Since the clinical question of the project relates to therapy, it requires an experimental study design such as a randomized controlled trial. Such approach allows minimizing the risk of bias in study results.

Setting/sample

The study will encompass eighty registered patients of the Oncology Department of the Local Community Hospital. All the patients were diagnosed with various stages of cancer and are currently undergoing long-term treatment. All participants must be over 18 and under 60 years of age.

Confidentiality

Only the current staff of the local hospital will be involved in the project and have access to patients’ profiles. The cases of the participants that will be analyzed in the intervention report will be anonymous. No names, appearance description, or personal facts will be disclosed.

Procedures/intervention

All recruited participants will be assessed to detect their initial level of depressive disorder. Later, they will be randomly allocated into the intervention and control groups. During two months of the trial, the control group will undergo regular care focused only on the physical aspect of cancer, while the intervention group will receive complex treatment involving psychotherapy, music therapy, and antidepressants.

Patients from the intervention group will receive psychotherapy treatment according to the practice described by Okuyama et al. (2017). During the first month, therapy sessions will be held in groups of up to 10 people two times a week. During the second month, each participant will undergo two private psychotherapy sessions.

Music therapy is based on the study by Zhou et al. (2015) and will be held three times a week. The purpose of such therapy is to create a relaxing environment and provide a patient with a possibility to meditate. All patients will be provided with headphones. Musical compositions will be borrowed from the existing study by Zhou et al. that proved to be effective for their participants (2015, p. 57).

The approach to using antidepressants was borrowed from the research made by Laoutidis and Mathiak (2013). Patients will be prescribed anti-depressants based on the results of the primary assessment and their health history.

Stakeholders

The executives from the Local Cancer Fund (LCF) and the Mental Health Organization (MHO) are involved in the planned project as stakeholders. The LCF will cover expenditures related to the necessary inventory and tools for the intervention. The MHO administration will provide supply of the necessary antidepressants for free for two months and give a 50% discount for further orders from their partners. The organization will also facilitate staff training and consultations throughout the project.

Instruments/scales and Measurement of Outcomes

To assess the collected data and measure the outcomes of the project, a qualitative research will be implemented. As recommended for randomized controlled trials, the scales and checklists from the Cochrane Collaboration’s tool will be used to define outcomes and prevent potential bias in the research (Zeng et al., 2015). Physiotherapy Evidence Database and Jadad Scale must be incorporated for evaluation as well (2015, p. 2).

Data Collection

The study requires a qualitative research and will incorporate such data collection techniques as surveys, interviews, and direct observation. Pre- and posttests will include specifically designed surveys. Two times a week data will be collected during group discussions in order to assess the progress of the intervention. To get a deeper understanding of the changes in patients’ physical and psychological state, staff members will observe and make notes of their behavior and group dynamics during the project. More specific data will be collected from private psychotherapy sessions during the second month of treatment.

Part V. Data Analysis

At the final stage of the study, the impact of depression oriented treatment on patient’s health will be analyzed. A general linear model with univariate analysis will be used to independently evaluate such dependent variables as anxiety level, depression level, tumor development, and the general quality of life. The statistics gained by means of univariate tests will be analyzed to estimate the change in patients’ physical and mental state. Such demographic data as age, cancer type, and cancer stage of a patient will be included.

The expected outcomes of the clinical change will provide another scientific evidence of the capacity of depression oriented treatment to stabilize the development of cancer. The planned therapies are believed to reduce emotional distress in patients and empower them to fight the illness. In patients with advanced and incurable stages of cancer, such treatment will improve the quality of their life and allow them to spend the last days with more comfort.