Suicide risk detection and mitigation in patients with head and neck cancer

项目总结/摘要 本K01提案的目标是为候选人提供精神病学方面的正式培训和指导 流行病学、心理肿瘤学和实施科学;追求独立职业所需的培训 在实施干预措施，以检测和减轻头颈部（HNC）癌症患者的自杀风险。 自杀是第十大死亡原因，在美国每11分钟就有1人死于自杀。之间 自杀风险较高的人是慢性病患者，包括癌症幸存者。自杀死亡率 HNC患者的发病率为63.4/100，000人-年，是美国普通人群的四倍。 显然，自杀在美国是一个重要的公共卫生危机，被认为是一个领先的健康指标， 健康人倡议。自杀意念筛查是一项以证据为基础的自杀预防和缓解措施 战略几项研究表明，对患者进行自杀意念筛查是可行和有效的 和行为在各种临床设置，包括一般，非精神病急诊室设置。食品 美国食品和药物管理局（FDA）已认可哥伦比亚自杀严重程度评定量表（C-SSRS）作为工具 用于筛选自杀意念和行为。然而，HNC中的自杀筛查干预措施 患者缺乏，部分原因是我们对与糖尿病相关的多层次障碍的理解存在差距。 筛查HNC患者的自杀风险。为了弥补这一差距，候选人将利用C-SSRS来 描述HNC患者的自杀风险，并测试C- SSRS作为HNC护理中的常规自杀筛查工具。通过与关键利益相关者的线人访谈， 候选人将确定患者、提供者和其他可能导致调查不理想的障碍， 目的1中HNC患者的自杀意念。在目标2中，考生将向一组 HNC患者，提供关于美国HNC患者自杀意念和严重程度的见解。另外还有按 当发现有自杀风险时，会设立风险管理/分流系统，提供跟进护理。目标3 将涉及对接受Aim 2中C-SSRS的患者子集进行混合方法评价，以引出 对C-SSRS管理的反馈，以及与供应商的汇报，以评估 C-SSRS作为HNC护理的常规部分。这项研究将通过提高我们的科学影响力， 我们对HNC背景下自杀筛查障碍的了解。它将产生重大的临床影响 通过C-SSRS在HNC护理中的新应用。所汲取的经验教训将用于今后的研究， HNC和整个癌症连续体。培训目标是解决候选人的科学差距， 精神病流行病学，精神肿瘤学，定性/混合方法研究设计和实施 科学完成此提案和培训将使候选人成为跨学科的独立 研究人员实施干预措施，以降低HNC人群的心理社会发病率。

PROJECT SUMMARY/ABSTRACT The goal of this K01 proposal is to provide the candidate with formal training and mentoring in psychiatric epidemiology, psycho-oncology and implementation science; training needed to pursue an independent career in implementing interventions to detect and mitigate suicide risks among head and neck (HNC) cancer patients. Suicide is the 10th leading cause of death, and 1 person dies by suicide every 11 minutes in the US. Among individuals at higher risk of suicide are chronic disease sufferers, including cancer survivors. The suicide mortality rate for HNC patients is 63.4 per 100,000 person-years, which is four times more than the general US population. Clearly, suicide is an important public health crisis in the US and is considered a leading health indicator by the Healthy People initiative. Screening for suicidal ideation is an evidence-based suicide prevention and mitigation strategy. Several studies have demonstrated that it is feasible and effective to screen patients for suicidal ideation and behavior in various clinical settings, including general, non-psychiatric emergency room settings. The Food and Drug Administration (FDA) has endorsed the Columbia Suicide Severity Rating Scale (C-SSRS) as the tool of choice for screening for suicidal ideation and behavior. However, suicide screening interventions among HNC patients are lacking, in part due to the gaps in our understanding of the multilevel barriers associated with screening HNC patients for risks of suicide. To address this gap, the candidate will utilize the C-SSRS to characterize suicide risk among HNC patients, and test effectiveness and potential implementability of the C- SSRS as a routine suicide screening tool in HNC care. Using informant interviews with key stakeholders, candidate will identify patient, provider and other barriers that could underlie the suboptimal investigation of suicidal ideation among HNC patients in Aim 1. In Aim 2, candidate will administer the C-SSRS to a group of HNC patients, providing insights on suicidal ideation and severity among HNC patients in the US. In addition, a risk management/triage system will be developed to provide follow-up care when suicide risk is detected. Aim 3 will involve a mixed-method evaluation with a subset of patients who received the C-SSRS from Aim 2 to elicit feedback on the administration of the C-SSRS, and a debrief with providers to assess future implementability of the C-SSRS as routine part of HNC care. This research will have scientific impact by enhancing our enhancing our knowledge of the barriers to screening for suicide in the HNC setting. It will have significant clinical impact through the novel utilization of the C-SSRS in HNC care. Lessons learned will be adopted for future studies in HNC and across the cancer continuum. The training objective is to address the candidate’s scientific gaps in psychiatric epidemiology, psycho-oncology, qualitative/mixed methods research design, and implementation science. Completion of this proposal and training will position the candidate as a transdisciplinary, independent investigator in implementing interventions to decrease psychosocial morbidity in the HNC population.