Background (1)

1. Intervention for Depression among Palliative Care Patients and their Family Members: A Training Program for Staff

2. Background (1) • Clinical depression identified as a significant problem among palliative care patients • Research indicates 25% of patients meet criteria for major depression • Studies suggest that depression is under-detected and under-treated in this group • Less than 50% are treated leading to decreased quality of care

3. Background(2) A number of issues unique to the palliative care setting act as barriers to providing care • Reluctance of patients to discuss emotion • Care staff primarily focus on physical care • Care staff have poor knowledge of depression and lack experience in recognising depression • Lack of standardised procedures for assessing and addressing mental health problems

4. Background (3) Few previous studies on training programs for depression for palliative care staff • Not comprehensive • Small sample sizes • Limited outcome measures • No control groups

5. Project Aims Development and evaluation of a depression training program for palliative care staff • Increases staff members knowledge, attitudes and self-efficacy in working with depressed patients, and reduces the perceived barriers • Improves early detection and monitoring of depressive symptoms. Increases referral rates • Enhances psychological support provided to patients and their family members

6. Project Outline • Conduct a needs analysis with palliative care staff/managers, patients’ family members • Develop a four-session training program for palliative care staff • Deliver and evaluate program for effectiveness in a controlled trial - 2 intervention groups (1 metro and 1 rural) - 1 control group

7. Needs Analysis Interviews with • 8 managerial staff • 10 non-managerial staff • 10 family members of patients in care

8. Themes from Needs Analysis • Limited knowledge regarding clinical features • Difficulties differentiating symptoms • Focus on physical symptoms • Low self-efficacy to provide support • Need for appropriate screening instruments • Lack of collaboration between palliative care staff and family members • Psychosocial needs of family not being met

9. Training Sessions Outline • Session 1: Understanding depression • Session 2: Detecting depression • Session 3: Responding to depression • Session 4: Family focus

10. Program Evaluation(1) • Staff Knowledge of depression (30 items) • Attitudes towards depression and caring for depressed patients and family (21 items) • Self-efficacy in detecting and working with depressed patients and family (16 items) • Perceived barriers to the provision of care (12 items)

11. Program Evaluation (2) • Effectiveness ascertained by number of patient referrals made for depression - Three months pre-training compared to - Three months post-training • Post-training interviews with patient family members assessing perceptions of care provision

12. Participants

13. Results(1) • Staff self-report questionnaires – there was a significant increase in staff knowledge, attitudes and self-efficacy in working with depression and a reduction in perceived barriers to care when working with depression, among staff completing the program compared to the control group

14. Results (2) • Depression referral rate data – number of referrals increased significantly between the pre-training and post-training at both EH (49%) and SWH (47.1%) sites. This suggest that the skills in detecting and responding in an appropriate way improved after completing the training program

15. Results(3) • Post-training interviews with family members - Data collected through interviews with faamily members suggest that few, if any, observable changes occurred in staff practices from pre-training. Note: 1. Accurate picture of such changes was difficult to gauge. 2. Family members were reflecting on all staff.

16. Challenges Encountered • Patient outcome measures – no direct measures • Family member interviews – difficult to note changes regarding staff • Staff retention at T3 – staff attrition due to staffing and management changes • Attitudinal changes in staff - not maintained

17. Future Directions • Patient outcome measures to be developed • Refresher courses for sustainability of improvements • Re-structured 2 session course appears to be more acceptable and has the potential to produce similar positive outcome.

18. Conclusions • Palliative care staff identify the need for , and benefit from depression training • Training is effective in improving staff knowledge, self-efficacy in providing care, decreasing perceived barriers to care provision and increasing referrals • Training is an appropriate mechanism to improve detection and care provision

19. Project Team • Professor Marita McCabe-Deakin University • Professor David Mellor - Deakin University • Dr. Tanya Davison – Deakin University • Professor Kuruvilla George – Eastern Health • Mr. Shane Storer – SW Healthcare • Dr. Juli Moran – Eastern Health • Dr. Eric Fairbank – SW Healthcare • Mr. David Hallford – Deakin University • Dr. Denisa Goldhammer – Deakin University