Progress

The team prepares and adapts materials for the effectiveness trial; applies to relevant ethics committees

All participants in the effectiveness trial will receive a self-care toolkit. Participants will be individually randomized, and half will receive regular telephone support from a trained self-care coach who will answer questions about the toolkit and guide patients as they use the tools.

Study sample follow-up ends, advisory committee reviews results

55 patients completed all three study questionnaires. The research team concluded that it is feasible to implement a supported self-care intervention for depression and began preparing the second phase of the study. Procedural problems to address during the trial include: 1) research staff will need to help in patient recruitment in larger clinics; 2) participation of the patients' family practitioner should not be a prerequisite to the recruitment of patients; 2) a face-to-face meeting with eligible patients is needed to request written informed consent; 3) a stepped approach, matching the coaching to patient needs and preferences is desirable.

Patient screening ends

1063 waiting room screening forms completed and returned to the study centre. 254 of these referred individuals were eligible for the second screening (presence of a targeted chronic disease and depressive symptoms). Of the individuals screened by telephone, 98 were eligible, and 63 completed the baseline questionnaire and provided written consent.

Interview and intervention administration begins

Recruited patients will complete a telephone questionnaire at three time points: baseline, 6-weeks after enrollment and 6-months after enrollment. Patients receive their self-care toolkit in the mail and the first call from their coach shortly after. The research team hopes to complete the 200-patient recruitment process by the end of November 2010.

Self-care coaches are trained

Coaches receive training from clinicians on the research team. Coaches must call registered patients once a week for the first three months of the study and once a month for the last three months. Training includes learning to manage patients' potential distress and learning to guide participating patients on how to use the self-care tools.

Screening in participating family physicians' offices begins

Participating family physicians begin distributing screening questionnaires in their waiting rooms. Patients must be 40 years or older, have a diagnosis of chronic physical illness and must be experiencing depressive symptoms. Completed questionnaires are faxed back to the research team who follows up with potentially eligible patients to confirm their eligibility and interest in the study.

Second meeting of the advisory committee

For a second time, research collaborators and community stakeholders meet with the DIRECT-sc team to approve final versions of the self-care tools that will be supplied to participating patients. Self-care support provided by coaches is also discussed, allowing the research team to finalize the intervention content and procedures.

Recruitment of family physicians begins

A random sample of family physicians practicing in Montreal is selected using the membership registries of the Collège des médecins du Québec. Letters are sent to introduce the project and a research assistant follows-up with the physician to schedule a brief meeting to explain the project in greater detail. Participating physicians agree to distribute short screening questionnaires in their waiting rooms. The research team hopes to recruit 60 family physicians.

Completion of physicians' and allied health professionals' focus groups

Family physicians, psychologists, social workers and nurses review the latest version of the self-care toolkit, which now includes a community resource list and a short documentary on the causes of and treatment options for depression. The type of support to offer patients practicing self-care is discussed. The team further develops the intervention, which will include weekly calls from a self-care coach who will answer any questions patients may have about their self-care toolkit.

Completion of the twelve-patient pilot study

Twelve patients from St. Mary's Hospital Center's psychiatry and family medicine departments participate in a two-week pilot study to test the acceptability of the research team's questionnaires and to give their first impressions of the self-care tools. Questionnaires are finalized and translated upon completion of the pilot study.

First meeting of the advisory committee

Direct-sc project research collaborators and community stakeholders are invited to give feedback on the first version of the self-care toolkit, which includes an information brochure, a mood monitoring notebook, an action plan, a book, a self-help guide and information on an interactive website. Committee members have the opportunity to comment on the research questions to ensure information from the study will be relevant and practical.