iManageAYA: Preparation and Optimization of a mHealth Intervention for Managing Depressive Symptoms in Adolescent and Young adult Cancer Survivors

iManageAYA：用于管理青少年和年轻癌症幸存者抑郁症状的移动健康干预措施的准备和优化

• 批准号: 10371463
• 负责人: Karly Mary Murphy
• 金额: $ 15万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-09 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10371463
• 关键词: Address; Adherence; Adolescent and Young Adult; Age; Award; Behavior Therapy; Behavioral; Breast Cancer survivor; Businesses; Cancer Survivor; Cessation of life; Child Rearing; Childbirth; Cognitive; Conduct Clinical Trials; Data; Development; Dissemination and Implementation; Education; Educational workshop; Engineering; Ensure; Evaluation; Evidence based intervention; Feedback; Future; General Population; Genetic; Goals; Health Care Costs; Hour; Incidence; Individual; Intervention; Interview; Knowledge; Laboratories; Lead; Malignant Neoplasms; Marriage; Medical; Mental Depression; Mentors; Methodology; Mindfulness Training; Mobile Health Application; National Cancer Institute; Oncology; Outcome; Participant; Persons; Phase; Population; Preparation; Prevalence; Procedures; Process; Provider; Public Health; Quality of life; Recommendation; Reporting; Research; Research Design; Research Personnel; Research Priority; Resources; Sampling; Schools; Science; Self Management; Site Visit; Technology; Testing; Training; Treatment/Psychosocial Effects; Work; acceptability and feasibility; age group; arm; associated symptom; base; cancer recurrence; career; career development; child bearing; comorbidity; cost; depressive symptoms; design; dissemination science; effective intervention; effectiveness implementation study; effectiveness implementation trial; efficacious intervention; efficacy testing; evidence base; experience; experimental study; health care service utilization; implementation science; improved; innovation; intervention cost; intervention effect; iterative design; mHealth; mortality risk; multiphase optimization strategy; peer; peer support; physical symptom; pilot test; preference; premature; prevent; prototype; psychosocial; remote delivery; skills; usability; user centered design

There are ~680,000 adolescent and young adult cancer survivors (AYACS) in the U.S., and this number is likely to grow as the incidence of cancer in this age-group is rising. AYACS experience significant disruptions to achieving normative developmental milestones (e.g. completion of education, developing a career, dating, marriage, child birth), which often results in elevated rates of depressive symptoms compared to healthy peers and other cancer survivors. Among cancer survivors, depressive symptoms associated with poorer quality of life, lower adherence to medical recommendations, increased healthcare utilization/costs, and elevated mortality risk. Though psychosocial interventions for depression are efficacious in the general population, few have been adapted for use with AYACS. Additionally, interventions to improve depressive symptoms have typically been provided in-person, which has resulted in many barriers to participation (e.g., distance, limited clinician availability “after hours”) that are problematic for AYACS who tend to have many competing commitments wuch as school, work, and parenting. Therefore, it is critical to develop AYACS-targeted interventions that can be delivered remotely and on-demand such as mobile health applications (mHealth apps). The objective of this proposal is to prepare and optimize a mHealth app to promote self-management of depressive symptoms among AYACS (iManageAYA), guided by the Multiphase Optimization Strategy (MOST) framework. MOST is a framework adapted from engineering that uses highly efficient factorial experiments to evaluate individual and combined effects of intervention components to determine which ones can be reduced, eliminated, or replaced to improve efficiency. During the K99 phase, I propose using an iterative user-centered design process to prepare a prototype of iManageAYA that is usable, acceptable, and feasible for AYACS. This intervention will consist of a core application and four evidence-based components: 1) behavioral activation; 2) cognitive restructuring; 3) mindfulness training; and 4) peer support. During the R00 phase, I will determine which intervention components reduce depressive symptoms using a full factorial experiment. I will use the results of this experiment to develop an intervention that only includes components that significantly contributed to reductions in depressive symptoms among AYACS, minimizing participant burden. I plan to propose future studies will test the efficacy of this optimized intervention, as well as strategies for its dissemination and implementation. In addition to the proposed research, I will extend my knowledge and skills in: 1) user-centered design; 2) the MOST approach; 3) the conduct of clinical trials with AYACS; 4) dissemination and implementation science and 5) professional development. This K99/R00 award will enable my transition to an independent career conducting innovative research to develop, evaluate, implement, and disseminate psychosocial interventions that address the unique needs of AYACS. My mentoring team and collaborators have the necessary skills and resources to assist me in achieving my goals and will ensure that I successfully transition to an independent investigator.

在美国，大约有68万青少年和年轻成人癌症幸存者（AYACS），这个数字是可能的