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

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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).