The final year of life is a critical time for both quality of life and medical costs.

Depression is likely to affect both quality of life and health care costs in the last year of life, but there has been little research into effective interventions for depression that are integrated with palliative care services.

This project aims to first identify the nature, prevalence and current management of depression in patients being treated by a specialist palliative care service for one or more chronic medical illnesses, including cancer. We will then find out how well these psychiatric needs are currently being met and the barriers to achieving this by interviewing staff and patients.

Based on these findings, and on our previous research, we will (working with the newly commissioned Oxford University Hospitals Psychological Medicine service), develop a new approach to managing depression that is integrated with palliative care.

We will then pilot and refine the new approach to this aspect of palliative care. Finally we aim to conduct a randomised controlled trial to evaluate the effect of this new approach to care on quality of life, cost of care and place of death with that achieved by usual palliative care for patients with depression. 

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