title: Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation?
abstract: OBJECTIVE
  To examine whether the effects of a nurse navigator intervention for cancer vary with baseline depressive symptoms.
  
  
  METHODS
  Participants were enrolled in a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N=251). This exploratory analysis used linear regression models to estimate the effect of a nurse navigator intervention on patient experience of care. Models estimated differential effects by including interactions between randomization group and baseline depressive symptoms. Baseline scores on the 9-item Patient Health Questionnaire (PHQ) were categorized into 3 groups: no depression (PHQ=0-4, N=138), mild symptoms of depression (PHQ=5-9, N=76) and moderate to severe symptoms (PHQ=10 or greater, N=34). Patient experience outcomes were measured by subscales of the Patient Assessment of Chronic Illness Care (PACIC) and subscales from an adaptation of the Picker Institute's patient experience survey at 4-month follow-up.
  
  
  RESULTS
  With the exception of the PACIC subscale of delivery system/practice design, interaction terms between randomization group and PHQ-9 scores were not statistically significant.
  
  
  CONCLUSIONS
  The intervention was broadly useful; we found that it was equally beneficial for both depressed patients and patients who were not significantly depressed in the first 4 months postdiagnosis. However, because of the small sample size, we cannot conclude with certainty that patients with depressive symptoms did not differentially benefit from the intervention.
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA. Electronic address: ludman.e@ghc.org.
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.affiliation: Yale University, New Haven, CT 06520, USA.
authors.forename: Ruth
authors.initials: R
authors.lastname: McCorkle
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Erin Aiello
authors.initials: EA
authors.lastname: Bowles
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Salene
authors.initials: S
authors.lastname: Jones
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Penfold
authors.affiliation: Group Health Research Institute, Seattle, WA 98101, USA.
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D015179:Colorectal Neoplasms / Q000523:psychology*; D003376:Counseling / Q000379:methods*; D003863:Depression / Q000628:therapy*; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009726:Nurses; D062526:Patient Navigation / Q000379:methods*; D016896:Treatment Outcome
keywords: Cancer; Depression; Navigation; Oncology
references.citation: J Gen Intern Med. 2001 Sep;16(9):606-13
references.pmid: 11556941
references.citation: J Clin Psychiatry. 2002;63 Suppl 8:24-34
references.pmid: 12044105
references.citation: JAMA. 2003 Jun 18;289(23):3095-105
references.pmid: 12813115
references.citation: Biometrics. 1988 Dec;44(4):1049-60
references.pmid: 3233245
references.citation: Gen Hosp Psychiatry. 1992 Jul;14(4):237-47
references.pmid: 1505745
references.citation: JAMA. 1995 Apr 5;273(13):1026-31
references.pmid: 7897786
references.citation: Arch Gen Psychiatry. 1996 Oct;53(10):924-32
references.pmid: 8857869
references.citation: Int J Psychiatry Med. 2004;34(3):247-58
references.pmid: 15666959
references.citation: Cancer. 2005 Apr 1;103(7):1494-502
references.pmid: 15726544
references.citation: Med Care. 2005 May;43(5):436-44
references.pmid: 15838407
references.citation: J Natl Cancer Inst Monogr. 2005;(35):3-11
references.pmid: 16287880
references.citation: Support Care Cancer. 2006 Aug;14(8):837-48
references.pmid: 16482448
references.citation: Lancet. 2008 Jul 5;372(9632):40-8
references.pmid: 18603157
references.citation: J Behav Med. 2010 Feb;33(1):1-14
references.pmid: 19784868
references.citation: N Engl J Med. 2010 Dec 30;363(27):2611-20
references.pmid: 21190455
references.citation: Lancet Oncol. 2011 Feb;12(2):160-74
references.pmid: 21251875
references.citation: Clin J Oncol Nurs. 2013 Feb;17(1):43-8
references.pmid: 23372095
references.citation: J Clin Oncol. 2014 Jan 1;32(1):12-8
references.pmid: 24276777
references.citation: Psychooncology. 2014 Feb;23(2):121-30
references.pmid: 24105788
references.citation: Lancet Oncol. 2014 Sep;15(10):1168-76
references.pmid: 25175097
references.citation: Lancet. 2014 Sep 20;384(9948):1099-108
references.pmid: 25175478
references.citation: J Clin Oncol. 2014 Nov 1;32(31):3540-6
references.pmid: 25287821
references.citation: JAMA. 1999 Nov 10;282(18):1737-44
references.pmid: 10568646
references.citation: Psychooncology. 2001 Jan-Feb;10(1):19-28
references.pmid: 11180574
references.citation: Biometrics. 2001 Mar;57(1):126-34
references.pmid: 11252587