Brief report
Electronic Screening and Decision Support for Poststroke Depression: An Exploration of Doctors' and Patients' Perceptions of Acceptability

https://doi.org/10.1016/j.apmr.2012.09.009Get rights and content

Abstract

Objective

To explore clinicians' and patients' perceptions of acceptability of an electronic screening and decision support system for poststroke depression.

Design

A mixed-methods study involved participants from 2 convenience samples.

Setting

Outpatient stroke and rehabilitation clinics.

Participants

Stroke patients (n=62) completed surveys. Seven clinicians working at clinics targeted by the depression screening process were interviewed using semi-structured interviews.

Interventions

Not applicable.

Main Outcome Measures

Patient data were analyzed from an acceptability survey. Qualitative data analysis involved an inductive thematic approach with constant comparison.

Results

Most patients found screening easy to complete and understand, important, and a good way of conveying information to the clinician. Most clinicians did not systematically discuss mood disturbances, with attenuating factors and barriers to identification both influencing identification. Variations in the management of mood centered on the use of pharmacotherapy and role overlap with general practitioners. The screening process assisted with identification and saved time during diagnosis and management.

Conclusions

The positive perceptions of patients and clinicians identified in this study support the concept of routine screening and feedback for poststroke depression. This process has the potential to improve poststroke depression practice to meet national guidelines; however, evaluation of impact on patient outcome is required.

Section snippets

Methods

Two convenience sample groups were recruited from the larger evaluation of the electronic decision support system within the outpatient stroke and rehabilitation clinics at the John Hunter Hospital in Newcastle, New South Wales, Australia.6 Stroke outpatients attending clinics immediately postdischarge from hospital or for follow-up care who consented to participate in the larger intervention trial were invited to complete an acceptability questionnaire after depression screening. Exclusion

Results

Sixty-two stroke survivors (mean age ± SD, 65±13y) completed an acceptability questionnaire, with most participants attending clinics at John Hunter Hospital (77%). Demographic data were available for only 49 of the 62 survey respondents, since initially the acceptability survey was in an anonymous format; however, this was changed to an identified format (hence demographic data are missing for the first 21% of participants who completed the survey). Of those for whom demographic data were

Discussion

This mixed-methods study indicated that the electronic screening process was considered nonburdensome to stroke survivors, with most reporting it was brief, easy to complete, and easy to understand. Clinicians recognized that PSD identification was tedious, difficult, and frequently disregarded during consultations.5 Interviewed clinicians reported rarely using screening tools; however, they indicated that receiving screening results made PSD identification easier compared with clinical

Conclusions

This study has revealed that perceptions of electronic PSD screening and decision support were positive for patients and stroke clinicians, supporting the concept of routine electronic screening and feedback as a beneficial and time-effective means of identifying PSD compared with current practice. This process potentially can allow for clinical practice to meet national and international stroke management guidelines regarding mood disturbances.

References (9)

  • N. Herrmann et al.

    Detection and treatment of post stroke depression: results from the registry of the Canadian Stroke Network

    Int J Geriatr Psychiatry

    (2011)
  • National Stroke Foundation. Clinical guidelines for stroke management. 2010. Available at:...
  • National clinical guidelines for stroke

    (2008)
  • S. Hart et al.

    Screening for depression after stroke: an exploration of professionals' compliance with guidelines

    Clin Rehabil

    (2008)
There are more references available in the full text version of this article.

Cited by (3)

Supported by the National Stroke Foundation.

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

View full text