Abstract
Anxiety and depression are common psychological experiences in patients who have advanced disease and are often unrecognized and undertreated. This study examined how primary care providers assess, identify and treat anxiety and depression in patients who have advanced disease, as well as to illustrate to what extent social work and mental health services are currently being utilized to address these psychological issues. Primary care providers at two rural clinics in Northern Wisconsin were invited to participate in this study, including Family Practice and Internal Medicine Physicians, Nurse Practitioners and Physician Assistants who provide primary care to patients, including patients who have advanced stages of disease. Of these two clinics, one clinic is piloting a Patient Centered Home Model of patient care and the other is a traditional primary care clinic. Nine Internal Medicine and Family Practice Physicians, Nurse Practitioners and Physician Assistants from one rural medical clinic participated in this study using a one time, qualitative interview by means of a semi-structured interview format. Inductive grounded theory methods were used to analyze the data.
Several themes were identified in this study which supports previous research such as the need for additional physician education; lack of standard screening tools; and the issue of time constraints that affect the physician’s ability to identify and treat anxiety and depression in palliative care patients. There were two surprise findings: one theme was that there was not a clear definition of palliative care, therefore affecting the identification of palliative care patients and the other was the high utilization and support for social workers in the primary care setting. The findings of this research support the need to implement social work services in the clinic setting to assist the primary care providers with many psychosocial issues including the emotional needs of patients who have advanced disease.