iManageAYA: Preparation and Optimization of a mHealth Intervention for Managing Depressive Symptoms in Adolescent and Young adult Cancer Survivors

iManageAYA：用于管理青少年和年轻癌症幸存者抑郁症状的移动健康干预措施的准备和优化

• 批准号: 10641663
• 负责人: Karly Mary Murphy
• 金额: $ 14.99万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-01 至 2023-09-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10641663
• 关键词: Address; Adherence; Adolescent and Young Adult; Adolescent and young adult cancer patients; Age; Award; Behavior Therapy; Behavioral; Breast Cancer survivor; Businesses; Cancer Survivor; Cessation of life; Child Rearing; Childbirth; Cognitive; Conduct Clinical Trials; Data; Development; Dissemination and Implementation; Education; Educational workshop; Engineering; Ensure; Evaluation; Evidence based intervention; Feedback; Future; General Population; Genetic; Goals; Health Care Costs; Hour; Incidence; Individual; Intervention; Interview; Knowledge; Laboratories; Malignant Neoplasms; Marriage; Medical; Mental Depression; Mentors; Methodology; Mindfulness Training; Mobile Health Application; National Cancer Institute; Oncology; Outcome; Participant; Persons; Phase; Population; Preparation; Prevalence; Procedures; Process; Provider; Public Health; Quality of life; Recommendation; Recurrent Malignant Neoplasm; Reporting; Research; Research Personnel; Research Priority; Resources; Sampling; Schools; Science; Self Management; Site Visit; Technology; Testing; Training; Treatment/Psychosocial Effects; Work; acceptability and feasibility; age group; arm; associated symptom; cancer recurrence; career; career development; child bearing; comorbidity; cost; depressive symptoms; design; dissemination science; effective intervention; effectiveness/implementation trial; efficacious intervention; efficacy testing; evidence base; experience; experimental study; health care service utilization; implementation science; improved; innovation; intervention cost; intervention effect; mHealth; mortality risk; multiphase optimization strategy; peer; peer support; physical symptom; pilot test; preference; premature; prevent; prototype; psychosocial; remote delivery; skills; usability; user centered design

There are ~680,000 adolescent and young adult cancer survivors (AYACS) in the U.S., and this number is likely to grow as the incidence of cancer in this age-group is rising. AYACS experience significant disruptions to achieving normative developmental milestones (e.g. completion of education, developing a career, dating, marriage, child birth), which often results in elevated rates of depressive symptoms compared to healthy peers and other cancer survivors. Among cancer survivors, depressive symptoms associated with poorer quality of life, lower adherence to medical recommendations, increased healthcare utilization/costs, and elevated mortality risk. Though psychosocial interventions for depression are efficacious in the general population, few have been adapted for use with AYACS. Additionally, interventions to improve depressive symptoms have typically been provided in-person, which has resulted in many barriers to participation (e.g., distance, limited clinician availability “after hours”) that are problematic for AYACS who tend to have many competing commitments wuch as school, work, and parenting. Therefore, it is critical to develop AYACS-targeted interventions that can be delivered remotely and on-demand such as mobile health applications (mHealth apps). The objective of this proposal is to prepare and optimize a mHealth app to promote self-management of depressive symptoms among AYACS (iManageAYA), guided by the Multiphase Optimization Strategy (MOST) framework. MOST is a framework adapted from engineering that uses highly efficient factorial experiments to evaluate individual and combined effects of intervention components to determine which ones can be reduced, eliminated, or replaced to improve efficiency. During the K99 phase, I propose using an iterative user-centered design process to prepare a prototype of iManageAYA that is usable, acceptable, and feasible for AYACS. This intervention will consist of a core application and four evidence-based components: 1) behavioral activation; 2) cognitive restructuring; 3) mindfulness training; and 4) peer support. During the R00 phase, I will determine which intervention components reduce depressive symptoms using a full factorial experiment. I will use the results of this experiment to develop an intervention that only includes components that significantly contributed to reductions in depressive symptoms among AYACS, minimizing participant burden. I plan to propose future studies will test the efficacy of this optimized intervention, as well as strategies for its dissemination and implementation. In addition to the proposed research, I will extend my knowledge and skills in: 1) user-centered design; 2) the MOST approach; 3) the conduct of clinical trials with AYACS; 4) dissemination and implementation science and 5) professional development. This K99/R00 award will enable my transition to an independent career conducting innovative research to develop, evaluate, implement, and disseminate psychosocial interventions that address the unique needs of AYACS. My mentoring team and collaborators have the necessary skills and resources to assist me in achieving my goals and will ensure that I successfully transition to an independent investigator.

美国约有 680,000 名青少年和年轻成人癌症幸存者 (AYACS)，这个数字很可能 随着这个年龄段癌症发病率的上升而增长。 AYACS 经历了严重的中断 实现规范的发展里程碑（例如完成教育、发展职业、约会、 结婚、生育），与健康同龄人相比，这通常会导致抑郁症状的发生率升高 和其他癌症幸存者。在癌症幸存者中，抑郁症状与生活质量较差相关， 对医疗建议的遵守率较低、医疗保健利用率/成本增加以及死亡风险升高。 尽管抑郁症的心理社会干预措施对普通人群有效，但很少有 适合与 AYACS 一起使用。此外，改善抑郁症状的干预措施通常是 面对面提供，这给参与带来了许多障碍（例如距离、临床医生有限） “下班后”的可用性）这对于 AYACS 来说是个问题，因为他们往往有许多相互竞争的承诺 比如学校、工作和养育孩子。因此，制定以 AYACS 为目标的干预措施至关重要 远程按需交付，例如移动健康应用程序（mHealth 应用程序）。此举的目的 提案是准备和优化移动医疗应用程序，以促进抑郁症状的自我管理 AYACS (iManageAYA)，以多阶段优化策略 (MOST) 框架为指导。大多数是一个 改编自工程学的框架，使用高效的因子实验来评估个人和 干预措施的综合影响，以确定哪些干预措施可以减少、消除或替代 以提高效率。在K99阶段，我建议使用以用户为中心的迭代设计流程来准备 对 AYACS 可用、可接受且可行的 iManageAYA 原型。这种干预措施将包括 一个核心应用程序和四个基于证据的组件：1）行为激活； 2）认知重建； 3） 正念训练； 4）同伴支持。在R00阶段，我将确定哪些干预组件 使用完整的析因实验减少抑郁症状。我将利用这个实验的结果来开发 仅包含显着减轻抑郁症状的干预措施 在 AYACS 中，最大限度地减少参与者的负担。我计划建议未来的研究将测试其功效 优化干预措施及其传播和实施策略。除了提议的 研究中，我将扩展我的知识和技能：1）以用户为中心的设计； 2）MOST方法； 3） 使用 AYACS 进行临床试验； 4）传播和实施科学，5）专业 发展。这个 K99/R00 奖项将使我能够过渡到从事创新的独立职业生涯 研究开发、评估、实施和传播心理社会干预措施，以解决独特的问题 AYACS 的需求。我的指导团队和合作者拥有必要的技能和资源来帮助我 实现我的目标并将确保我成功过渡为独立调查员。