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 老年癌症患者（OACs）是一个庞大且不断增长的人群，具有高水平的抑郁症状 与更高的发病率和死亡率相关。尽管普遍实施的危难 在癌症护理机构的筛查程序中，大约一半的痛苦OAC没有接受心理治疗， 健康服务，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。因此，在危难筛查方面投入的资源不会导致 改善病人护理或减少痛苦。需要工具来帮助抑郁的OAC启动心理健康 治疗Trevino博士（PI）的试点工作确定了OAC中精神卫生保健的独特障碍（例如，负担 多个医疗预约）和OAC的需求（例如，远程递送以减少旅行负担）。Sirey博士 （Co-I）开发了一种名为“开门”的有效干预措施，可改善以下人群的心理健康治疗开始： 抑郁的居家老人在此基础上，本文提出了一种改进的门户开放的方法， 对于OACs，评估OACs中的Open Door（Open Door for Cancer; OD-C），以提高心理健康率 抑郁OAC的治疗启动，并确定OD-C实施策略。本研究的目标 主要是：（1）修改开放式空调的开放门;（2）评估OD-C在开放式空调中的可行性和可接受性;（3）测试 OD-C对心理健康治疗启动率初步疗效;（4）探讨启动意向 心理健康治疗，治疗开始时间，和潜在的介质OD-C;和（5）确定多 影响OD-C实施的水平因素。为达致这些目标，我们会与 OAC和医学及心理社会肿瘤学提供者（n=6组;每组n=6-8例受试者），以确定 OAC和癌症护理环境的干预修改。然后，我们将在一个随机的 在一项对照试验中，将n=100名OAC随机分配至OD-C或家庭护理组，并在基线和6- 12个月时进行评估。 随机分组后12周，以检查 对心理健康治疗启动率进行干预。此外，我们将探讨OD-C对意图的影响 开始心理健康治疗和开始心理健康治疗的时间以及潜在的介质 根据健康信念模型（即，痛苦的严重程度，心理健康的障碍 治疗，心理健康治疗的感知益处，自我效能和行动线索）。此外，我们会 收集参与OD-C（n=30）和肿瘤学提供者（n=30）的OAC对实施的反馈 障碍、促进者和策略。基于健康信念模型，这项研究建立在以前的工作， 老年心理健康和投资于癌症护理中的痛苦筛查，以解决心理健康方面的差距。 OAC的健康护理。这些结果将为未来NIH R 01申请提供信息，以进行OD-C的多中心试验 它考虑了患者的特征、变化机制和实施结果（即，覆盖范围）。