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

项目摘要/摘要 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、心理肿瘤学和执行学；追求独立职业所需的培训 在实施干预措施以检测和降低头颈部(HNC)癌症患者的自杀风险方面。 自杀是第十大死因，在美国，每11分钟就有一人死于自杀。其中 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患者的发病率为每10万人年63.4人，是美国总人口的四倍。 显然，自杀在美国是一种重要的公共卫生危机，被 健康人的倡议。自杀意念筛查是一种循证的自杀预防和缓解 策略。多项研究表明，对患者进行自杀意念筛查是可行和有效的。 以及各种临床环境中的行为，包括普通的、非精神科的急诊室环境。食物 美国药品监督管理局(FDA)已批准哥伦比亚自杀严重程度评定量表(C-SSRS)作为工具 是筛查自杀意念和行为的首选。然而，在HNC中进行自杀筛查干预 缺乏患者，部分原因是我们对与以下方面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。为了解决这一差距，应聘者将利用C-SSR来 描述HNC患者的自杀风险，并测试C- SSRS作为HNC护理中常规自杀筛查工具。利用线人对关键利益相关者的采访， 候选人将确定患者、提供者和其他可能成为次优调查基础的障碍 目标1中HNC患者的自杀意念。在目标2中，候选人将对一组 HNC患者，提供关于美国HNC患者的自杀意念和严重程度的见解。此外，a 将发展风险管理/分流系统，在发现自杀风险时提供后续护理。目标3 将涉及一项混合方法评估，对从AIM 2接受C-SSRS的患者子集进行评估 对C-SSR管理的反馈，以及与提供商的汇报，以评估未来的实施情况 C-SSRS作为HNC护理的常规部分。这项研究将产生科学影响，通过加强我们的 我们对在HNC环境中筛查自杀的障碍的了解。这将对临床产生重大影响。 通过C-SSRS在HNC CARE中的新应用。吸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在以下方面的科学差距 精神病学流行病学、心理肿瘤学、定性/混合方法研究设计和实施 科学。完成这项提议和培训将使候选人成为一名跨学科的、独立的 调查员在实施干预措施以减少HNC人群的心理社会发病率方面发挥了重要作用。

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.