Correlates of Oncologist-issued Referrals for the Psycho-oncology Service: Findings from a Voluntary Depression Screening System for Cancer Patients
임상가가 정신종양 서비스로 진료 의뢰시 관여하는 요인: 암환자를 위한 자발적 우울증 스크리닝 시스템에서의 결과

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의과대학 임상의과학과
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서울대학교 대학원
학위논문 (석사)-- 서울대학교 대학원 : 임상의과학과, 2015. 2. 함봉진.
Introduction: Under-recognized and thus under-treated depression negatively affects cancer patients. As a solution, a voluntary depression screening system was designed and pilot-tested. Within this system, we examined the correlates of oncologist-issued referrals for the psycho-oncology service (POS).

Methods: The Electronic Voluntary Screening and Referral System for Depression (eVSRS-D) comprised self-screening, automated reporting, and referral guidance for oncologists. Freely using touch-screen kiosks in a tertiary cancer hospital, participants with cancer completed the Patient Health Questionnaire-9 (PHQ-9), received its result, and reported their willingness for the POS. At oncology appointments, oncologists issued POS referrals considering participants screening result and willingness. Logistic regression analyses explored the correlates of depression symptom severity, participants referral willingness, and actual POS referral.

Results: Among 838 participants, 56.3% reported moderately severe or severe depression symptoms, 30.5% wished for the POS, and 14.8% were referred. More severe depression symptoms were negatively correlated with stomach cancer (versus breast: Odds Ratio [OR]=0.60, p=0.038) and positively with cancer surgery history (OR=1.39, p=0.019). Participants referral willingness correlated their being single or separated (versus married: OR=1.85
p=0.002), performance status (Eastern Cooperative Oncology Group Performance Score [ECOS-PS] 2 versus 0: OR=0.56, p=0.042), recurrence or metastasis status (yes versus no: OR=0.73
p=0.043), and the severity of depression symptoms (moderately severe versus minimal to moderate: OR=5.44, p<0.001
severe versus minimal to moderate: OR=153.13, p<0.001). Multivariate analyses showed that correlates of the actual referral were participants employment status (housewives versus employed: OR=1.72, p=0.035), poorer performance (ECOG-PS 1 versus 0: OR=2.02, p=0.005
ECOG-PS 2 versus 0: OR=3.27, p=0.001), active cancer treatment status (OR=1.71, p=0.022), and referral willingness (OR=7.14, p<0.001). The association between the actual referral and the severity of depression symptoms (severe versus minimal to moderate: OR=2.67, p<0.001), shown in univariate analyses, became insignificant. Non-referred cases (n=714) were mostly (87.1%) due to postponed decisions.

Conclusions: The system may self-select a population highly prevalent of significant depression symptoms. Participants willingness was the strongest predictor of their referral trajectory. Participants having a job, better performance, not being actively treated may lower their chance of being referred, independent to their depression symptom severity.
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Clinical Medical Sciences (임상의과학과)Theses (Master's Degree_임상의과학과)
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