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

项目摘要 老年癌症患者(OAC)是一个具有高度抑郁症状的庞大且不断增长的人群 这与更高的发病率和死亡率有关。尽管普遍实施了危难 在癌症护理环境中的筛查程序中，大约一半的苦恼OAC患者没有接受精神治疗 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 以证据为基础的干预措施的效果很差。因此，投入在遇险筛查上的资源不会导致 改善病人护理或减少痛苦。需要工具来帮助抑郁症OAC患者启动心理健康 治疗。特雷维诺博士(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，远程分娩以减少旅行负担)。西里博士 (CO-I)开发了一种名为Open Door的有效干预措施，改善了#年心理健康治疗的启动 忧郁的呆在家里的老年人。在此之前工作的基础上，拟议的研究旨在修改打开的门 对于OAC，评估OAC中的Open Door(癌症Open Door；OD-C)以提高心理健康比率 抑郁症OAC的治疗启动，并确定OD-C实施策略。这项研究的目标是 主要目的是：(1)改进开放式车门；(2)评估车载空调系统中OD-C的可行性和可接受性；(3)测试 OD-C对心理健康治疗启动率的初步影响(4)启动意向探讨 心理健康治疗，开始治疗的时间，以及OD-C的潜在介体；以及(5)确定多个 影响OD-C实施的水平因素为了实现这些目标，我们将通过以下方式开展重点小组 OAC以及医疗和心理社会肿瘤学提供者(n=6个小组；每个小组n=6-8名参与者)以确定 OAC和癌症护理环境的干预修改。然后我们将在随机的情况下进行OD-C试验 将100名OAC随机分为OD-C组或常规护理组，并在基线和6个月内进行评估。 并在随机化后12周检查该方案的可行性、可接受性和初步疗效 心理健康治疗启动率的干预。此外，我们还将探讨OD-C对意向的影响 启动心理健康治疗和开始心理健康治疗的时间和潜在的介导者 受健康信念模式影响(例如，感知到的痛苦严重程度、感知到的心理健康障碍 治疗、心理健康治疗的感知益处、自我效能和行动提示)。此外，我们还将 收集参与OD-C的OAC(n=30)和肿瘤学提供者(n=30)对实施的反馈 障碍、促进者和战略。基于健康信念模型，这项研究建立在 老年心理健康和癌症护理中痛苦筛查的投资，以解决心理上的差距 OAC的医疗保健。这些结果将为未来NIH R01应用程序进行OD-C的多站点试验提供依据 它考虑了患者的特征、改变的机制和实施结果(即REACH)。

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).