Collaborative Care to Reduce Depression and Increase Cancer Screening Among Low-Income Urban Women
Condition: Depression; Breast Cancer Screening; Cervical Cancer Screening; Colorectal Cancer Screening
MeSH terms: Colorectal Neoplasms; Uterine Cervical Neoplasms; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Bronx County, New York is the poorest urban county in the U.S.A., and residents are almost
      entirely Latino or African American. Cancer is the leading cause of premature death in the
      Bronx, with morality rates significantly higher than for New York City as a whole.
      Low-income/minority populations are more likely to be diagnosed with preventable and
      late-stage cancers than the general population, in part, due to lower screening rates. While
      research has addressed screening barriers in low-income/minority groups, depression, a
      common,potentially critical barrier, has received scant attention. Research suggests that
      depressed women are less likely to engage in cancer screening, especially mammography and Pap
      testing. The link between mental health and cancer screening is particularly important to
      address in the Bronx, which has the highest rates of self-reported serious psychological
      distress (a measure closely related to depression) in New York City. Depression affects
      almost 1 in 4 minority women, and while minorities often seek help for depression in primary
      care, primary care depression management often does not meet evidence-based standards.
      Drawing on the expertise and close collaboration of Bronx medical and social service
      providers and patient stakeholders, this study will determine whether a collaborative care
      intervention that addresses both depression and cancer screening needs simultaneously among
      women ages 50-64 is more effective at improving cancer screening and patient-reported
      outcomes for women with depression than an existing evidence-based cancer screening
      intervention alone.

      To achieve this, the investigators will compare the effectiveness of these two interventions
      using a randomized controlled trial (RCT). In partnership with six Bronx Federally Qualified
      Health Centers (FQHCs), the investigators will recruit approximately 800 women ages 50-64 who
      screen positive for depression and are non-adherent with recommended cervical, breast, and/or
      colorectal cancer screenings. The investigators specific aims are to: 1) compare the impact
      of the two interventions on patient-reported outcomes, including cancer screening knowledge
      and attitudes, self-efficacy, depression-related stigma, provider referrals, participation in
      mental health care, medication adherence, quality of life, satisfaction with care and
      treatment decisions, and depression; 2) compare the effectiveness of the two interventions in
      increasing breast, cervical, and colorectal cancer screening; 3) determine whether reducing
      depression increases the likelihood that low-income women 50-64 will receive cancer
      screening; 4) determine whether effectiveness of the two interventions in increasing cancer
      screening varies according to patient characteristics, such as duration of depression,
      presence of other chronic conditions, and obesity.

      This study is designed to increase the investigators understanding of how to enhance primary
      care systems' ability to improve a range of outcomes related to cancer screening and
      depression among low-income minority women, and how to best support this population in making
      cancer-screening decisions.
    


Intervention name(s): Prevention Care Management for Depression and Cancer Screening; Prevention Care Management for Cancer Screening
Intervention type(s): Behavioral; Behavioral
Other intervention name(s): Collaborative Care Intervention (CCI); Prevention Care Manager (PCM)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Depression; Breast Cancer Screening; Cervical Cancer Screening; Colorectal Cancer Screening