Depression is common in cancer patients and untreated depression is too common and has dramatic negative consequences for both patients and their caregivers. While multiple interventions for depression have demonstrated efficacy, they are under-employed due to multiple barriers. Oncology staff often fails to recognize depression. Oncology patients are unlikely to report depressive symptoms for a range of reasons. A system that limits time between oncology staff and patients only worsens the situation. Screening programs may help to increase the identification of likely depression in cancer patients but it is unclear how to best use the information obtained from the use of screening tools. In this project we will employ a depression screening in 2 busy ambulatory lung cancer clinics at the University of Kentucky Markey Cancer Center (UKMCC) and Memorial Sloan Kettering Cancer Center (MSKCC). We have chosen lung cancer because it affects both genders, is associated with a high degree of emotional distress and is understudied considering how common a disease it is. We will screen all patients with lung cancer, anticipating that nearly 40% of them will screen above the normal range based on data from our previous work. Patients who screen above normal for depressive symptoms will be assessed for a range of characteristics including self-efficacy. Patients will then be randomly assigned to one of four groups in a 2x2 factorial design: in group 1 (standard care control) the results of the screening will not be made available to either the patient nor the physician); in group 2 (patient only) the results of the screening will be made available to the patient, in group 3 (physician only) the results of the screening will be made available to the physician and in group 4 (patient and physician) the results of the screening will be made available to both the patient and the physician. Following the visit, we will assess recognition/discussion of depressive symptoms, recommendations made for treatment and the quality of the interaction from the patient's point of view. This will allow us to study how best to utilize screening information as well as how these various approaches interact with patient characteristics (both psychological and demographic).
