A telehealth intervention to improve initiation of mental health treatment among depressed older adults with cancer

远程医疗干预可改善患有癌症的抑郁老年人的心理健康治疗

• 批准号: 10425023
• 负责人: Kelly McConnell
• 金额: $ 43.56万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10425023
• 关键词: Address; Aging; Appointment; Attitude; Benchmarking; Cancer Patient; Cancer Survivor; Characteristics; Client satisfaction; Clinic; Complex; Cues; Data; Depressed mood; Discipline; Distress; Elderly; Emergency department visit; Enrollment; Ensure; Evidence based intervention; Feedback; Focus Groups; Future; General Population; Goals; Healthcare Systems; Hospitalization; Individual; Institution; Intervention; Interview; Investments; Malignant Neoplasms; Mediator of activation protein; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Modification; Morbidity - disease rate; Nature; Oncology; Outcome; Participant; Patient Care; Patients; Persons; Population; Procedures; Provider; Public Health; Quality of life; Questionnaires; Randomized; Randomized Controlled Trials; Reporting; Research; Resources; Risk; Risk Factors; Screening Result; Screening procedure; Self Efficacy; Services; Severities; Social Work; Social Workers; Structure; Suicide; Surgeon; Telephone; Testing; Time; Travel; Treatment Efficacy; United States National Institutes of Health; Videoconferencing; Vulnerable Populations; Work; acceptability and feasibility; associated symptom; attentional control; barrier to care; base; brief intervention; cancer care; cancer diagnosis; clinical care; clinically significant; college; depressive symptoms; design; efficacious intervention; efficacy evaluation; functional decline; geriatric mental health; health belief; health goals; health literacy; hospital readmission; human old age (65+); implementation barriers; implementation facilitators; implementation outcomes; implementation strategy; improved; innovation; intervention effect; medical appointment; mortality; multi-site trial; patient oriented; patient screening; peer; physical conditioning; physical symptom; pilot test; primary outcome; psychosocial; remote delivery; screening; secondary outcome; social stigma; suicidal risk; telehealth; therapy development; tool; treatment as usual

PROJECT ABSTRACT Older adults with cancer (OACs) are a large and growing population with high levels of depressive symptoms that are associated with greater morbidity and mortality. Despite widespread implementation of distress screening procedures in cancer care settings, approximately half of distressed OACs do not receive mental health services, in part because 50-75% of cancer patients decline mental health referrals and implementation of evidence-based interventions is poor. As a result, the resources invested in distress screening do not lead to improved patient care or reduced distress. Tools are needed to help depressed OACs initiate mental health treatment. Pilot work by Dr. Trevino (PI) identified unique barriers to mental health care in OACs (e.g., burden of multiple medical appointments) and needs of OACs (e.g., remote delivery to reduce travel burden). Dr. Sirey (Co-I) developed an efficacious intervention titled Open Door that improves mental health treatment initiation in depressed homebound older adults. Based on this prior work, the proposed study aims to modify Open Door for OACs, evaluate Open Door in OACs (Open Door for Cancer; OD-C) to improve rates of mental health treatment initiation in depressed OACs, and identify OD-C implementation strategies. The goals of this study are to: (1) modify Open Door for OACs; (2) evaluate the feasibility and acceptability of OD-C in OACs; (3) test the preliminary efficacy of OD-C on rates of mental health treatment initiation; (4) explore intent to initiate mental health treatment, time to treatment initiation, and potential mediators of OD-C; and (5) identify multi- level factors influencing implementation of OD-C. To meet these goals, we will conduct focus groups with OACs and medical and psychosocial oncology providers (n=6 groups; n=6-8 participants per group) to identify intervention modifications for OACs and cancer care settings. We will then pilot test OD-C in a randomized controlled trial in which n=100 OACs are randomized to OD-C or Usual Care and assessed at baseline and 6- and 12-weeks post-randomization to examine the feasibility, acceptability, and preliminary efficacy of the intervention on rates of mental health treatment initiation. Further, we will explore the impact of OD-C on intent to initiate mental health treatment and time to mental health treatment initiation and potential mediators informed by the Health Belief Model (i.e., perceived severity of distress, perceived barriers to mental health treatment, perceived benefits of mental health treatment, self-efficacy, and cues to action). In addition, we will collect feedback from OACs who participate in OD-C (n=30) and oncology providers (n=30) on implementation barriers, facilitators, and strategies. Grounded in the Health Belief Model, this study builds on prior work in geriatric mental health and investments in distress screening in cancer care to address a gap in the mental health care of OACs. These results will inform a future NIH R01 application to conduct a multi-site trial of OD-C that considers patient characteristics, mechanisms of change, and implementation outcomes (i.e, reach).

项目摘要 癌症的老年人（OAC）是人口众多，抑郁症状高水平 与更大的发病率和死亡率有关。尽管很广泛地实施困扰 癌症护理环境中的筛查程序，大约一半的痛苦的OAC不会接受心理 卫生服务，部分原因是50-75％的癌症患者拒绝心理健康转诊和实施 基于证据的干预措施很差。结果，投资于遇险筛查的资源不会导致 改善患者护理或减少困扰。需要工具来帮助抑郁的OAC启动心理健康 治疗。 Trevino博士（PI）的飞行员工作确定了OAC中精神保健的独特障碍（例如，负担 多次医疗预约）和OAC的需求（例如，远程交货以减轻旅行负担）。 Sirey博士 （CO-I）开发了一种有效的干预措施，标题为“开放门”，可改善心理健康治疗的起始 沮丧的家中老年人。基于这项先前的工作，拟议的研究旨在修改敞开的门 对于OAC，请评估OACS（癌症的开门； OD-C）以提高心理健康率 在抑郁的OAC中进行治疗，并确定OD-C实施策略。这项研究的目标 要：（1）修改OAC的敞开门； （2）评估OAC中OD-C的可行性和可接受性； （3）测试 OD-C对心理健康治疗开始率的初步疗效； （4）探索意图发起 心理健康治疗，治疗时间的时间以及OD-C的潜在介体； （5）确定多 影响OD-C实施的水平因素。为了实现这些目标，我们将与 OAC，医学和心理肿瘤学提供者（n = 6组； n = 6-8个参与者）以识别 OAC和癌症护理环境的干预修改。然后，我们将在随机的 对照试验，其中n = 100 OAC被随机分配到OD-C或通常的护理，并在基线和6-- 和12周随机化，以检查该的可行性，可接受性和初步疗效 干预心理健康治疗开始率。此外，我们将探讨OD-C对意图的影响 启动心理健康治疗和时间进行心理健康治疗的时间和潜在的调解人 由健康信念模型（即，遇险的严重程度，对心理健康的障碍）告知 治疗，心理健康治疗的感知益处，自我效能感和行动线索）。此外，我们将 收集参加OD-C（n = 30）和肿瘤提供商（n = 30）的OAC的反馈 障碍，促进者和战略。基于健康信念模型，本研究以先前的工作为基础 老年心理健康和对癌症护理中遇险筛查的投资，以解决精神的差距 OAC的医疗保健。这些结果将为未来的NIH R01应用程序提供，以进行OD-C的多站点试验 这考虑了患者特征，变化机制和实施结果（即触及）。