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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

基本信息

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
项目类别：
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

项目摘要

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