Operationalizing Depression Screening in Ambulatory Palliative Care: A Quality Improvement Project

Background: Depression is common in the palliative care setting and impacts outcomes. Operationalized screening is unusual in palliative care.

Local problem: Lack of operationalized depression screening at two ambulatory palliative care sites.

Methods: A fellow-driven quality improvement initiative to implement operationalized depression screening using the patient health questionnaire-2 (PHQ-2). The primary measure was rate of EMR-documented depression screening. Secondary measures were clinician perspectives on the feasibility and acceptability of implementing the PHQ-2.

Intervention: The intervention is a clinic-wide implementation of PHQ-2 screening supported by note templates, brief clinician training, referral resources for clinicians, and opportunities for indirect psychiatric consultation.

Results: Operationalized depression screening rates increased from 2% to 38%. All clinicians felt incorporation of depression screening was useful and feasible.

Conclusions: Operationalized depression screening is feasible in ambulatory palliative care workflow, though optimization through having screening be completed prior to clinician visit might improve uptake.