Implementing an Evidence-Based Clinical Protocol to Increase Depression Screening in an Outpatient Oncology Practice

Written by Rachel M. Easters, JoAnn S. Oliver, & Regina A. George

doi: https://doi.org/10.13178/jnparr.2026.1601.1604

Abstract

Background: Depression in oncology patients is associated with decreased adherence to cancer treatment and poor quality of life. Untreated depression can also increase health care costs as these patients may have more emergency room visits and hospitalizations, or unscheduled clinic visits. Therefore, early screening for depression will assist providers in the diagnosis and timely management of depression in oncology patients.

Objective: This project aimed to improve the identification and management of depression among oncology patients in an outpatient clinic.

Methods: A quality improvement initiative introduced a standardized depression screening and management protocol for patients with cancer in an outpatient hematology and oncology practice in Central Alabama. Data were collected before and after implementation to evaluate rates of depression screening, Patient Health Questionnaire (PHQ-9) completion, and subsequent clinical interventions guided by PHQ-9 scores. Demographic variables, including gender, cancer type, and treatment intent, were also obtained. Descriptive and inferential statistical analyses were conducted to examine changes in depression screening and treatment practices following protocol implementation.

Results: There was a statistically significant increase in depression screening. At the pre-implementation stage, 314 patients were eligible to participate in the depression screening. However, none of the patients completed the PHQ-9 test. After the implementation, 288 patients were eligible to participate in the depression screening and 91 of them completed the PHQ-9 test. This was a significant increase in the screening rates. Furthermore, of the 91 patients who completed the PHQ-9 test, 26.4% of them had scores of seven or greater. In addition, patients with scores of seven or greater were significantly more likely to receive an intervention for their depression compared to patients with scores of six or less. No relationship was found between PHQ-9 completion or changes made based on depression score with gender, cancer type, or treatment intent.

Conclusion: Routine depression screening is feasible in the outpatient oncology setting, and patients who screen positive are more likely to receive appropriate clinical interventions. Future research should examine the effectiveness of depression screening and management strategies across diverse cancer types.

Keywords: depression, screening, oncology, cancer, PHQ-9