2.  Clinical depression identified as a significant problem among palliative care patients  Research indicates 25% of patients meet criteria for major depression  Studies suggest that depression is under- detected and under-treated in this group  Less than 50% are treated leading to decreased quality of care

3. A number of issues unique to the palliative care setting act as barriers to providing care  Reluctance of patients to discuss emotion  Care staff primarily focus on physical care  Care staff have poor knowledge of depression and lack experience in recognising depression  Lack of standardised procedures for assessing and addressing mental health problems

4. Few previous studies on training programs for depression for palliative care staff  Not comprehensive  Small sample sizes  Limited outcome measures  No control groups

5. Development and evaluation of a depression training program for palliative care staff Increases staff members knowledge, attitudes and self-efficacy in working with depressed patients, and reduces the perceived barriers Improves early detection and monitoring of depressive symptoms. Increases referral rates Enhances psychological support provided to patients and their family members

6.  Conduct a needs analysis with palliative care staff/managers, patients’ family members  Develop a four-session training program for palliative care staff  Deliver and evaluate program for effectiveness in a controlled trial - 2 intervention groups (1 metro and 1 rural) - 1 control group

7. Interviews with  8 managerial staff  10 non-managerial staff  10 family members of patients in care

8. Limited knowledge regarding clinical features Difficulties differentiating symptoms Focus on physical symptoms Low self-efficacy to provide support Need for appropriate screening instruments Lack of collaboration between palliative care staff and family members Psychosocial needs of family not being met

9.  Session 1: Understanding depression  Session 2: Detecting depression  Session 3: Responding to depression  Session 4: Family focus

10.  Staff Knowledge of depression (30 items)  Attitudes towards depression and caring for depressed patients and family (21 items)  Self-efficacy in detecting and working with depressed patients and family (16 items)  Perceived barriers to the provision of care (12 items)

11.  Effectiveness ascertained by number of patient referrals made for depression - Three months pre-training compared to - Three months post-training  Post-training interviews with patient family members assessing perceptions of care provision

12. Participants MetroRegionalControlTotal N24353190 Nurses16222563 Allied Health813627 Previous training in depression 17%51%42%39% Years working in palliative care 5.310.47.58.0 Years of formal training 2.94.63.93.8

13.  Staff self-report questionnaires – there was a significant increase in staff knowledge, attitudes and self-efficacy in working with depression and a reduction in perceived barriers to care when working with depression, among staff completing the program compared to the control group

14.  Depression referral rate data – number of referrals increased significantly between the pre-training and post-training at both EH (49%) and SWH (47.1%) sites. This suggest that the skills in detecting and responding in an appropriate way improved after completing the training program

15.  Post-training interviews with family members - Data collected through interviews with faamily members suggest that few, if any, observable changes occurred in staff practices from pre-training. Note: 1. Accurate picture of such changes was difficult to gauge. 2. Family members were reflecting on all staff.

16.  Patient outcome measures – no direct measures  Family member interviews – difficult to note changes regarding staff  Staff retention at T3 – staff attrition due to staffing and management changes  Attitudinal changes in staff - not maintained

17.  Patient outcome measures to be developed  Refresher courses for sustainability of improvements  Re-structured 2 session course appears to be more acceptable and has the potential to produce similar positive outcome.

18.  Palliative care staff identify the need for, and benefit from depression training  Training is effective in improving staff knowledge, self-efficacy in providing care, decreasing perceived barriers to care provision and increasing referrals  Training is an appropriate mechanism to improve detection and care provision

19.  Professor Marita McCabe-Deakin University  Professor David Mellor - Deakin University  Dr. Tanya Davison – Deakin University  Professor Kuruvilla George – Eastern Health  Mr. Shane Storer – SW Healthcare  Dr. Juli Moran – Eastern Health  Dr. Eric Fairbank – SW Healthcare  Mr. David Hallford – Deakin University  Dr. Denisa Goldhammer – Deakin University