Depression Screening & Treatment in Ovarian Cancer

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DESCRIPTION (provided by applicant): Dr. Eileen Shinn earned her Ph.D. in Clinical Psychology from Ohio University and is a postdoctoral fellow in the Department of Behavioral Science at M.D. Anderson Cancer Center. Dr. Shinn will use the K07 award to train with a mentoring team comprised of medical and psychosocial experts at M. D. Anderson and four national experts in depression and primary care research (Drs. James Coyne, Lynn Rehm, John Williams, James Bray). This project has a longitudinal design with an embedded feasibility study to evaluate an innovative intervention for depression. The revised prospective screening plan has been expanded to include a hierarchical screening strategy for depression, as well as additional questions about timing of screening, quality of care received, and basic psychological processes which may affect depression. On the other hand, the pilot intervention has been scaled down and now offers patients a choice of treatment, reflecting the reality of depression treatment in managed-care settings. The training plan now includes formal coursework and workshops suggested by the 4 co-mentors, as well as annual training trips to Dr. James Coyne at U. Penn, and regularly scheduled face-to-face meetings with Drs. Lynn Rehm and James Bray, and to a lesser extent, Dr. John Williams. Formal agreements and specific roles with the mentoring team have been documented and are presented. The research and training plan will be conducted at M.D. Anderson, which has a commitment to research and training with numerous didactic and collaborative opportunities. The Gynecologic Cancer Center at M.D. Anderson treats 250-300 different ovarian cancer patients per year. Major depression is the most prevalent psychiatric disorder in cancer patients and severely disables patients' quality of life. Yet depression is underdiagnosed and inadequately treated when recognized. The research plan proposes to address many of the barriers that hinder the detection and treatment of major depression in busy oncology practice settings. The screening plan now features a brief 2-phase screening method which may demonstrate positive predictive value well above other screening instruments. The pilot intervention will test the feasibility and acceptability among depressed ovarian cancer patients. It will be delivered in the patient's home by telephone and a structured cognitive-behavioral therapy (CBT) journal. The pilot intervention will last 10 sessions over 3 months and cover a range of cognitive-behavioral skills. Each skill will suggest a choice of applications ranging from side-effect management and pain reduction, to concerns about losses in functioning. Drs. Rehm and Taylor will co-supervise Dr. Shinn in the CBT administration. This intervention is innovative and has not been done before with any group of cancer patients, including ovarian cancer patients.