Improving Parkinson's Disease Care through Systematic Screening for Depression.
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2024-10
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Abstract
Background
Depression is common in Parkinson's disease (PD) but is underrecognized clinically. Although systematic screening is a recommended strategy to improve depression recognition in primary care practice, it has not been widely used in PD care.Methods
The 15-item Geriatric Depression Scale (GDS-15) was implemented at 5 movement disorders clinics to screen PD patients. Sites developed processes suited to their clinical workflow. Qualitative interviews with clinicians and patients provided information on feasibility, acceptability, and perceived utility.Results
Prior to implementation, depression screening was recorded in 12% using a formal instrument; 64% were screened informally by clinical interview, and no screening was recorded in 24%. Of 1406 patients seen for follow-up care during the implementation period, 88% were screened, 59% using the GDS-15 (self-administered in 51% and interviewer administered in 8%), a nearly 5-fold increase in formal screening. Lack of clinician or staff time and inability to provide the GDS-15 to the patient ahead of the visit were the most commonly cited reasons for lack of screening using the GDS-15; 378 (45%) patients completing the GDS-15 screened positive for depression, and 137 were enrolled for a 12-month prospective follow-up. Mean GDS-15 scores improved from 8.8 to 7.0 (P < 0.0001) and the 39-item Parkinson's Disease Questionnaire emotional subscore from 42.2 to 36.7 (P = 0.0007).Conclusions
Depression screening in PD using a formal instrument can be achieved at much higher levels than is currently practiced, but there are barriers to implementing this in clinical practice. An individual site-specific process is necessary to optimize screening rates.Type
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Marras, Connie, Zachary Meyer, Hongliang Liu, Sheng Luo, Sneha Mantri, Allison Allen, Sydney Baybayan, James C Beck, et al. (2024). Improving Parkinson's Disease Care through Systematic Screening for Depression. Movement disorders clinical practice, 11(10). pp. 1212–1222. 10.1002/mdc3.14163 Retrieved from https://hdl.handle.net/10161/33685.
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Scholars@Duke
Sheng Luo
Sneha Arun Mantri
I am a movement disorders specialist with a clinical practice focused on the care of people with Parkinson disease (PWP) and other movement disorders. I am interested in ways to improve the quality of care for patients with chronic neurodegenerative conditions, particularly translating clinically effective treatments and lifestyle modifications (e.g. exercise) into the “real world.” While a growing body of evidence demonstrates that physical activity, including high-intensity exercise, is feasible for PWP and leads to improved motor and non-motor outcomes, translating that knowledge into practice has been challenging. My research in this area focuses on the impact of patient/doctor communication and social determinants of health on promoting or preventing physical activity among PWP.
In addition to my clinical training, I hold a Master of Science in Narrative Medicine from Columbia University. This unique program, which grew out of the larger field of medical humanities, expands the conceptual framework of clinical medicine to incorporate patient perspective and social experience. I conduct mixed-methods research to design and implement interventions that are actually meaningful to the target population(s). As an example, in my study of Veterans with PD, I was able to conduct qualitative cluster analysis of Veterans’ self-reported barriers and motivators of adherence to exercise recommendations, reporting for the first time the unique barriers faced by this patient population. Additional funded projects using a narrative medicine approach have included (1) exploring the lexicon of burnout among clinical and non-clinical employees; (2) understanding the experience of fatigue and psychosis among PwP and their care-partners; (3) exploring the interactions between border-crossing in literature and border-crossing in medical education/practice.
In particular, narrative medicine offers guideposts toward a revitalized practice of medicine and medical education. In 2020, I was appointed Director of Medical Humanities at Duke, leading a team of clinician scholars in understanding moral injury and structural inequities in medicine. Under this umbrella, I co-direct the interprofessional course Moral Movements in Medicine; teach in the first-year Clinical Skills Immersion, the second-year Cultural Determinants of Health Disparities, and the fourth-year Medical Humanities courses; and mentor third-year students in the Medical Humanities study track.
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