Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy

Depression and anxiety symptom network structure among patients with coronary heart disease and association with quality of life: protocol for a multicentre cross-sectional and prospective longitudinal study

BACKGROUND

Anxiety and depression are critical mental health problems among persons with coronary heart disease (CHD). The range of symptoms is an important stressor for adverse cardiovascular events, and these symptoms can be involved in various ways during the course of CHD. However, the characteristics and mechanisms of comorbidity between the two mental states from the viewpoint of symptom interactions in patients with CHD remain unclear. Therefore, we aim to apply a symptom-oriented approach to identify core and bridge symptoms between anxiety and depression in a population with CHD and to identify differences in network structure over time and symptomatic link profiles.

METHODS AND ANALYSIS

We designed a multicentre, cross-sectional, longitudinal study of anxiety and depression symptoms among patients with CHD. We will evaluate degrees of symptoms using the Generalized Anxiety Disorder Scale, the Patient Health Questionnaire and the WHO Quality of Life-Brief version. Patients will be followed up for 1, 3 and 6 months after baseline measurements. We will analyse and interpret network structures using R software and its packages. The primary outcomes of interest will include centrality, bridge connections, estimates, differences in network structures and profiles of changes over time. The secondary outcome measures will be the stability and accuracy of the network. By combining cross-sectional and longitudinal analyses, this study should elucidate the central and potential causative pathways among anxiety and depression symptom networks as well as their temporal stability in patients with CHD.

ETHICS AND DISSEMINATION

The project conforms to the ethical principles enshrined in the Declaration of Helsinki (2013 amendment) and all local ethical guidelines. The ethics committee at the University of South China approved the study (Approval ID: 2023-USC-HL-414). The findings will be published and presented at conferences for widespread dissemination.

TRIAL REGISTRATION NUMBER

ChiCTR2300075813.

Brief trauma-informed care training to enhance health care providers' knowledge, comfort, and implementation of trauma-informed care in primary care clinics: A pilot effectiveness study

Trauma-informed care (TIC) training may be valuable for patient-facing health care providers within primary care in urban health care settings serving patients with high levels of trauma exposure. This study tested the pilot effectiveness of a clinic-wide TIC initiative to enhance providers' knowledge, comfort in caring for trauma-exposed patients, and implementation of TIC within a primary care clinic of an urban safety net hospital using a single-arm longitudinal within-subjects design. Measures were obtained at baseline (T1), posttraining (T2), 1-month (T3), and 6-months (T4). Twenty-nine providers who completed TIC training were included in study analyses. Twenty-one completed T2 and 14 completed T3 and T4. Knowledge was measured with the Providers' Knowledge Regarding Injury-Related Posttraumatic Stress, comfort with a researcher-generated two-item measure, and TIC implementation with an eight-item binary scale from the Trauma Provider Survey. Repeated-measures general linear model examining within-subjects change over time in knowledge was significant (n = 8; F₃ = 4.74, p = .01, ηp² = .40); the model measuring change in comfort was not significant but trending (n = 9; F₃ = 4.56, p = .06). The model examining change in TIC implementation from T1 to T4 was not significant (n = 14; F3 = 4.32, p = .21). This pilot study demonstrated the preliminary effectiveness of a brief TIC training on improving health care provider knowledge and comfort working with trauma-exposed patients that sustained through 6-months posttraining. The findings indicate that additional support is needed to change behaviors in provider implementation of TIC in primary care clinic settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Screening for Emotional Distress in Patients with Cardiovascular Disease

PURPOSE OF REVIEW

In this article, we discuss the relationship between emotional distress and common cardiovascular disease condition, including coronary artery disease, atrial fibrillation, congestive heart failure, mechanical circulatory support, and heart transplant. We review screening measures that have been studied and used in clinical practice for each condition, as well as priorities for future research.

RECENT FINDINGS

Studies consistently demonstrate failing to identify and treat emotional distress in patients with cardiovascular disease is associated with adverse outcomes. However, routine emotional distress screening is not formally recommended for all cardiovascular disease conditions and is limited to depression screening in select patient populations. Future research should focus on evaluating the validity and reliability of standardized screening measures across the scope of emotional distress in patients with or at risk for cardiovascular disease. Other areas of future research include implementation of evidence-based pharmaceutical treatments and integrated behavioral health approaches and interventions.

Comparison of analog and digital patient decision aids for the treatment of depression: a scoping review

Introduction

Patient decision aids (PDAs) are important tools to empower patients and integrate their preferences and values in the decision-making process. Even though patients with mental health problems have a strong interest in being more involved in decision making about their treatment, research has mainly focused on PDAs for somatic conditions. In this scoping review, we focus on patients suffering from depression and the role of PDAs for this patient group. The review offers an overview of digital and analog PDAs, their advantages and disadvantages as well as recommendations for further research and development.

Methods

A systematic search of the existing literature guided by the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - extension for scoping reviews (PRISMA-ScR) was conducted. Three electronic literature databases with the appropriate thematic focus were searched (PubMed, PsycInfo, and Web of Science). The search strategy used controlled and natural language to search for the key concepts decision aids and depression. The articles were selected in a two-step process guided by predefined inclusion and exclusion criteria. We narratively synthetized information extracted from 40 research articles.

Results

We included 40 articles in our review. Our review revealed that there is more focus on digital PDAs in research than in clinical practice. Digitalization can enhance the benefits of PDAs by developing tools that are more efficient, interactive, and personalized. The main disadvantages of both types of PDAs for the treatment of depression are related to time, dissemination, and capacity building for the health care providers. Digital PDAs need to be regularly updated, effective strategies for their dissemination and acceptance need to be identified, and clinicians need sufficient training on how to use digital PDAs. There is more research needed to study which forms of PDAs are most appropriate for various patient groups (e.g., older adults, or patients with comorbidities), and to identify the most effective ways of PDAs' integration in the clinical workflow. The findings from our review could be well aligned with the International Patient Decision Aids Standards.

Discussion

More research is needed regarding effective strategies for the implementation of digital PDAs into the clinical workflow, ethical issues raised by the digital format, and opportunities of tailoring PDAs for diverse patient groups.

Human Factors and Organizational Issues: Contributions from 2022

OBJECTIVES

To review publications in the field of Human Factors and Organisational Issues (HF&OI) in the year 2022 and to assess major contributions to the subject.

METHOD

A bibliographic search was conducted following refinement of standardized queries used in previous years. Sources used were PubMed, Web of Science, and referral via references from other papers. The search was carried out in January 2023, and (using the PubMed article type inclusion functionality) included clinical trials, meta-analyses, randomized controlled trials, reviews, case reports, classical articles, clinical studies, observational studies (including veterinary), comparative studies, and pragmatic clinical trials.

RESULTS

Among the 520 returned papers published in 2022 in the various areas of HF&OI, the full review process selected two best papers from among 10 finalists. As in previous years, topics showed development including increased use of Artificial Intelligence (AI) and digital health tools, advancement of methodological frameworks for implementation and evaluation as well as design, and trials of specific digital tools.

CONCLUSIONS

Recent literature in HF&OI continues to focus on both theoretical advances and practical deployment, with focus on areas of patient-facing digital health, methods for design and evaluation, and attention to implementation barriers.

A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (The Transform DepCare Study)

BACKGROUND

Few real-world examples exist of how best to select and adapt implementation strategies that promote sustainability. We used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens.

METHODS

Informed by the Dynamic Sustainability Framework, we applied the Behaviour Change Wheel to our prior mixed methods to identify key sustainability behaviors and determinants of sustainability before specifying corresponding intervention functions, behavior change techniques, and implementation strategies that would be acceptable, equitable and promote key tenets of sustainability (i.e., continued improvement, education). Drawing on user-centered design principles, we enlisted 22 national and local stakeholders to operationalize and adapt (e.g., content, functionality, workflow) a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability.

RESULTS

After reviewing the long-term impact of early implementation strategies (i.e., external technical support, quality monitoring, and reimbursement), we identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. The most acceptable, equitable, and feasible intervention functions that would facilitate ongoing improvement included environmental restructuring, education, training, modeling, persuasion, and enablement. We determined that a waiting room delivered shared decision-making and psychoeducation patient tool (DepCare), the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key adaptations in response to dynamic contextual factors included expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).

CONCLUSION

We provide a roadmap for designing behavioral theory-informed, implementation strategies that promote sustainability and employing user-centered design principles to adapt strategies to changing mental health landscapes.