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.

美国有约680,000名青少年和年轻的成人癌症生存（AYACS），这一数字可能是 随着这个年龄段的癌症事件的增长正在增长。 AYACS经历了重大干扰 实现正常发展的里程碑（例如完成教育，发展职业，约会， 婚姻，儿童出生），与健康的同龄人相比，这通常会导致抑郁症状率升高 和其他癌症存活。在癌症存活中，与生活质量较差有关的抑郁症状， 降低对医疗建议的依从性，增加医疗保健利用/成本以及死亡率升高。 尽管对抑郁症的社会心理干预措施在普通人群中有效，但很少有人 适用于AYACS。此外，改善抑郁症状的干预措施通常是 提供的面对面，这导致了许多参与障碍（例如距离，有限的临床 可用性“下班”）对于倾向于拥有许多竞争承诺的AYACS来说是有问题的 作为学校，工作和育儿。因此，至关重要的是开发以AYACS为目标的干预措施 交付远程和按需提供的移动健康应用程序（MHealth应用程序）。这个目的 建议是准备和优化一个MHealth应用程序，以促进自我管理抑郁症状的自我管理 AYACS（Imanageaya），以多相优化策略（大多数）框架为指导。大多数是 改编自工程改编的框架，该工程使用高效的阶乘实验来评估个人和 干预组件的结合效果以确定可以减少，消除或更换的效果 提高效率。在K99阶段，我建议使用以用户为中心的迭代设计过程来准备 imanageaya的原型，可用于AYACS。这种干预将包括 核心应用和四个基于证据的组件：1）行为激活； 2）认知餐厅； 3） 正念训练； 4）同伴支持。在R00阶段，我将确定哪些干预组件 使用完整的阶乘实验减少抑郁症状。我将使用该实验的结果开发 干预措施，仅包括大量导致抑郁症状的组成部分 在AYAC中，最大程度地减少了伯恩的参与者。我计划提出未来的研究将测试这一点的效率 优化的干预措施以及其传播和实施的策略。除了提议 研究，我将在以下方面扩展我的知识和技能：1）以用户为中心的设计； 2）最多的方法； 3） 用AYACS进行临床试验； 4）传播和实施科学和5）专业 发展。这个K99/R00奖将使我能够过渡到独立职业，从事创新的创新 研究以开发，评估，实施和传播对独特的社会心理干预措施 AYACS的需求。我的心理团队和合作者具有必要的技能和资源来帮助我 实现我的目标，并将确保我成功地过渡到独立的调查员。