How can guidelines improve the diagnosis and management of major depression in patients with severe somatic diseases?
Michaud, L., University Hospital Center of Vaud, Center of Clinical Epidemiology, and Department of Psychiatry, Lausanne, Switzerland, Voellinger, R., University Hospital Center of Vaud, Center of Clinical Epidemiology, Lausanne, Switzerland, Burnand, B., University Hospital Center of Vaud, Center of Clinical Epidemiology, Lausanne, Switzerland, Stiefel, F., Department of Psychiatry, Lausanne, Switzerland |
Introduction: After the development of specific guidelines for the management of Major Depression (MD) in patients with somatic diseases (1), an implementation study was conducted with the aim to evaluate their impact on detection and management of MD.
Methods: Intervention study in two wards of a university hospital (Oncology and ENT) consisted of diffusion of the Guidelines on the Intranet of the hospital followed by two interactive sessions with clinical residents, one of them with an actor playing a depressed cancer patient. Outcome: Discharge letters of 285 patients prior and of 285 patients after the intervention were analysed, searching for diagnoses, treatment or discussion of MD.
Results: No statistical difference was found concerning the number of new diagnoses before and after the intervention. Further analyses will determine if an improvement was observed for other outcomes.
Conclusion: A minimal intervention to diffuse and implement Guidelines on MD was not successful in improving the detection of depressive disorders. Further results and relevant implications of this study for palliative care will be discussed.
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