Development of an informatics pathway from screening to online services for depression in an oncology setting (iPath*D)

项目摘要 抑郁症每年影响多达20%的癌症患者，尽管基于证据的研究不断扩大， 治疗，大多数人不接受治疗。治疗存在三个主要障碍：检测率低， 精神卫生知识普及和治疗可及性有限，在农村地区更为严重。创新 信息学解决障碍的方法存在：自动筛选，通过决策辅助（DA）增强MHL， 通过独立于地点的在线循证治疗，如计算机化的 认知行为疗法和虚拟咨询。然而，在确定筛选和 将癌症环境中未满足心理健康需求的个人与治疗联系起来。R21的目标是 是开发一种新的在线治疗途径（iPath*D），并建立其可接受性、可用性和 可行性iPath*D将是一个在线平台，用于连接临床显著性筛查阳性的患者 抑郁症在癌症设置的一系列在线和面对面的循证治疗，促进了 交互式DA. iPath*D旨在增加抑郁症筛查以及相关知识和访问 to，evidence-based循证治疗in patients患者with cancer癌症. iPath*D将与患者和临床医生一起开发， VT的农村癌症中心，那里没有普遍的抑郁症筛查，治疗选择有限。 具体目标是：目标1。采用以用户为中心的策略，开发一个在线途径， 筛选肿瘤学中的抑郁症治疗;以及目标2。确定可用性、可接受性和 在临床上实施iPath*D的可行性及其对MHL、筛查和 治疗率。该研究测试了以下假设：（1）iPath*D将是可接受的，高度可用的， 初步证明MHL、筛查率和治疗可及性增加的影响。的发展 iPath*D遵循以用户为中心的设计模式。在Aim 1中，来自癌症中心的抑郁症患者 （n=15）将通过参与式设计活动共同设计iPath*D，以告知 iPath*D，以及低保真和高保真iPath*D原型的开发，这些原型将经历多轮迭代 iPath * D通过广泛的可用性评估，确保iPath*D超越可用性指标。在目标2中， 开放标签、单组试验，患者在癌症中心开始治疗，评分10≤ PHQ-9 ≤27 （n=30），将接收iPath*D。将评估真实的世界可用性、可接受性和可行性，并进行初步评估 MHL、筛查和治疗获得率、治疗启动、依从性、QOL和抑郁症数据 将收集症状改善情况。这项研究在开发和测试一种新的服务方面具有创新性 提供模式（iPath*D），解决现有的护理障碍。结果预计将有一个重大的 通过为使用在线治疗途径提供原则证明， 帮助农村癌症患者中心理健康需求未得到满足的人数达到前所未有的水平。

PROJECT SUMMARY Depression affects up to 20% of patients with cancer each year and despite the expansion of evidence-based treatments, most individuals do not receive treatment. Three key barriers to treatment exist: low detection, low mental health literacy (MHL) and limited treatment accessibility, exacerbated in rural settings. Innovative informatics solutions to barriers exist: automating screening, enhancing MHL through decision aids (DA) and increasing accessibility via location-independent, online evidence-based treatments, such as computerized cognitive behavioral therapy and virtual consultations. Yet there is a gap in identifying strategies to screen and connect individuals with unmet mental health needs in cancer settings to treatments. The objective for this R21 is to develop a novel online pathway to treatment (iPath*D) and establish its acceptability, usability and feasibility. iPath*D will be an online platform that connects patients screening positive for clinically significant depression in cancer settings to a range of online and in-person evidence-based treatments, facilitated by an interactive DA. iPath*D is designed to increase depression screening as well as knowledge about, and access to, evidence-based treatment in patients with cancer. iPath*D will be developed with patients and clinicians in a rural cancer center in VT where there is no universal depression screening and treatment options are limited. The specific aims are: Aim 1. Employ user-centered strategies to develop an online pathway from screening to treatment for depression in oncology; and Aim 2. Determine usability, acceptability and feasibility of implementing iPath*D in clinic and its preliminary impact on MHL, screening and treatment rates. The study tests the hypotheses that: (1) iPath*D will be acceptable and highly usable and will demonstrate preliminary impact of increased MHL, screening rates and treatment access. The development of the iPath*D follows a user centered design model. In Aim 1 patients from the cancer center with depression (n=15) will co-design iPath*D via participatory design activities to inform the design and functionality of iPath*D, and development of low and high-fidelity iPath*D prototypes, which will go through rounds of iterative development, with extensive usability evaluations, ensuring iPath*D surpasses usability metrics. In Aim 2, an open label, single arm pilot, with patients beginning treatment at the cancer center, scoring 10≤ PHQ-9 ≤27 (n=30), will receive iPath*D. Real world usability, acceptability and feasibility will be assessed, and preliminary data on MHL, rates of screening and treatment access, treatment initiation, adherence, QOL, and depression symptom improvement will be gathered. This research is innovative in developing and testing a novel services delivery model (iPath*D) that addresses existing barriers to care. The results are expected to have a major positive impact by providing proof-of-principle for the use of an online pathway to treatment with the potential for reaching an unprecedented number of individuals in rural cancer settings with unmet mental health needs.