Low-income, minority cancer patients who drop out of depression treatment

UnrestrictedDepression is one of the most common symptoms of cancer, having a profound impact on patients' quality of life, immune response, morbidity, adherence to treatment, and even mortality. Although medication and counseling are effective in reducing depressive symptoms in cancer patients, there is an increasing need to understand factors that contribute to dropout (and retention) of low-income, minority cancer patients to depression treatment.; The aim of this study was to explore and understand the barriers and enablers contributing to low-income minority cancer survivors' participation and completion of depression treatment, within the context of an effectiveness treatment trial (ADAPt-C study). Such perspectives were gained through in-depth, telephone interviews with 20 patients who had dropped out of treatment, compared to 10 similar patients' who had completed depression treatment. Additional understanding about the dropout barriers were gained through secondary analysis of provider clinical notes. Face-to-face and telephone interviews with providers offered a list of strategies to retain patients to treatment.; Findings revealed that patients who dropped out of treatment perceived and described key barriers which interfered with their treatment completion: cancer-related, depression treatment-related, informational, instrumental, cultural, and systems-related. Taken together, dropouts often described "multiple confounding barriers." Completers experienced equally as many "multiple confounding barriers", however were able to continue and complete treatment. Potential explanations for this discrepancy can be found within some of the discrete barriers and associated narratives themselves. Analyses of dropout clinical notes from providers help reveal that additional barriers contributed to dropout: Enabling Family factors and Additional Enabling Psychological Coping factors. Provider interviews indicated that providers can provide feasible strategies which address some of the various patient-identified barriers: 1) Depression treatment strategies; 2) Informational strategies, 3) Instrumental strategies; 4) Recruitment strategies; 5) Cultural strategies; and 6) Systems' strategies. These results point to implications in the following areas: theoretical, research study design, clinical social work, community-based, and further research in the areas of health behavior decision-making, the influence of motivation, and self-efficacy. This adherence study of low-income, minority depressed cancer patients is especially important to future research and real-world depression care among cancer patients, particularly those from hard-to-reach populations