Barriers and facilitators to implementation of evidence-based depression and distress treatment in adult oncology: A systematic review.

Abstract

e13588 Background: Depression and psychological distress are common among cancer patients and are associated with increased mortality, yet uptake of evidence-based treatments remains low. While prior studies describe barriers to care, no systematic review has synthesized determinants using a structured implementation science framework. We identified barriers and facilitators to uptake and continuation of evidence-based depression/distress treatment in adult oncology patients and mapped them to Consolidated Framework for Implementation Research (CFIR) 2.0 constructs. Methods: We conducted a systematic review with a protocol registered on Open Science Framework. Searches of PubMed/MEDLINE, Embase, APA PsycINFO, Web of Science, and Cochrane identified qualitative and mixed-methods studies examining evidence-based depression/distress treatment in adult cancer patients. Extracted barriers and facilitators were mapped to CFIR 2.0 constructs. Results: The search yielded 7275 unique citations; 36 studies met inclusion criteria (n = 3777 participants). 14 papers elicited patient perspectives, 15 focused on healthcare professionals (HCPs), and 7 included patients, carers, and HCPs. 20 papers reported general barriers and facilitators to psychosocial support, and 16 focused on specific interventions (n = 8 for psychotherapy; n = 5 for collaborative care; n = 1 for antidepressants; n = 1 for support groups; and n = 1 for exercise); n = 5 used telehealth formats. Preliminary mapping identified prominent themes in the Individuals, Innovation, and Inner Setting domains. Among patients, barriers reflected reduced Capability (cancer-related fatigue, cognitive burden), limited Opportunity (competing treatment demands, time constraints), and variable Motivation (emotional avoidance, stigma). Facilitators included perceived need, readiness to engage, and belief in treatment benefit. Within the Innovation domain, barriers aligned with Complexity and Design, including usability challenges and time/administrative demands, whereas clear module progression, structured exercises, and reminders facilitated engagement. Within the Inner Setting, limited personnel and training hindered delivery, while embedded psychosocial services in oncology workflows and clinician endorsement and referral promoted uptake. Broader policy-level factors were relatively less represented. Conclusions: Successful implementation of depression and distress treatment in adult oncology patients depends on patient-level readiness, intervention design, and organizational context. Targeted strategies that reduce cognitive and logistical burden, improve usability, and integrate mental health services into oncology practice may improve uptake and engagement. Ongoing analysis will clarify multilevel determinants to inform implementation of psychosocial care.