Creating a Clinical Care Pathway for Depressive Symptoms and Disorders in Long-Term Care: A Modified Delphi Process

Objectives: To create an evidence- and expert-informed clinical care pathway focused on identifying and treating depressive symptoms and disorders in long-term care (LTC) residents. Design: Modified Delphi survey. Setting and Participants: Delphi participants were LTC health care providers, LTC administrators, friend/family caregivers of residents living in LTC, and residents of LTC. Methods: Initial survey statements were developed based on evidence and expert opinion. The survey was distributed in as many rounds as required to reach agreement among participants. Survey participants used Likert scale responses to rate their agreement with each statement describing a step of the clinical care pathway. Statements were revised between rounds based on participant feedback and median and interquartile range values. Results: To reach a consensus among participants on statements, 2 rounds of survey distribution were required. Twenty-six participants completed both rounds of the survey. Statements were organized into 4 categories: depression detection, identifying contributors to depression, symptom management, and coordination of care. Clinicians identified critical statements that were considered foundational to pathway function. Conclusions and Implications: The generated statements provide steps for identifying and managing depression among residents of LTC. These steps can be further tested in practice Canada-wide to improve care for residents. Steps that detail care outside current practice, such as staff education on depression detection and access to nonpharmacologic treatments, may require additional resources. During statement revisions, participants disagreed on when depression should be assessed, how validated depression assessment tools should be used, and how to account for depressive history and comorbidities as part of management. Further research is required to understand the barriers to providing care for depression before pathway implementation.